Provider Demographics
NPI:1689808040
Name:SIMMONS, ANN KATHLEEN (MS, RD, CDE)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:KATHLEEN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9680 W TROPICANA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8293
Mailing Address - Country:US
Mailing Address - Phone:702-335-0097
Mailing Address - Fax:702-920-7671
Practice Address - Street 1:9680 W TROPICANA AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8293
Practice Address - Country:US
Practice Address - Phone:702-335-0097
Practice Address - Fax:702-920-7671
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV933594133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education