Provider Demographics
NPI:1891173795
Name:SIMMONS, KRISTEN (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:D'ANDREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:610 W GERMANTOWN PIKE STE 150
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1062
Mailing Address - Country:US
Mailing Address - Phone:908-256-0462
Mailing Address - Fax:
Practice Address - Street 1:1068 W BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5104
Practice Address - Country:US
Practice Address - Phone:908-256-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN609651367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered