Provider Demographics
NPI:1689336786
Name:SIMMONS, KIJAN A (RN,NP)
Entity Type:Individual
Prefix:
First Name:KIJAN
Middle Name:A
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:RN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 SPANISH FORK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0688
Mailing Address - Country:US
Mailing Address - Phone:424-443-8036
Mailing Address - Fax:
Practice Address - Street 1:2414 SPANISH FORK AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0688
Practice Address - Country:US
Practice Address - Phone:424-443-8036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV837731163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse