Provider Demographics
NPI:1205192317
Name:SIMMONS, KRISTIE UNIACKE (MS, RD, CEDS-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:UNIACKE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MS, RD, CEDS-C
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:
Other - Last Name:UNIACKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:679 S SWADLEY ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228
Mailing Address - Country:US
Mailing Address - Phone:203-770-9947
Mailing Address - Fax:
Practice Address - Street 1:68 PARMALEE HILL RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1039
Practice Address - Country:US
Practice Address - Phone:203-770-9947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
1068318133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered