Provider Demographics
NPI:1811593320
Name:SIMONS, STEPHANIE ANNE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE
Last Name:SIMONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANNE
Other - Last Name:SIMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:11137 W 200 RD
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUND
Mailing Address - State:KS
Mailing Address - Zip Code:66010-9683
Mailing Address - Country:US
Mailing Address - Phone:620-768-9949
Mailing Address - Fax:
Practice Address - Street 1:11137 W 200 RD
Practice Address - Street 2:
Practice Address - City:BLUE MOUND
Practice Address - State:KS
Practice Address - Zip Code:66010-9683
Practice Address - Country:US
Practice Address - Phone:620-768-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS79411363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner