Provider Demographics
NPI:1821048679
Name:SIMMS, LOUISE KELLY (PA)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:KELLY
Last Name:SIMMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1113B LINCOLN PARK RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-9573
Mailing Address - Country:US
Mailing Address - Phone:859-481-9008
Mailing Address - Fax:859-481-9004
Practice Address - Street 1:2195 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3516
Practice Address - Country:US
Practice Address - Phone:859-323-6371
Practice Address - Fax:859-257-3585
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYPA926363AM0700X, 363AS0400X, 363A00000X
KY001940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYQ56167Medicare UPIN
KYK180280Medicare PIN