Provider Demographics
NPI:1629522966
Name:SIMMONS, KEWANNA
Entity Type:Individual
Prefix:
First Name:KEWANNA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-8012
Mailing Address - Country:US
Mailing Address - Phone:173-421-7617
Mailing Address - Fax:
Practice Address - Street 1:537 ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-8012
Practice Address - Country:US
Practice Address - Phone:173-421-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide