Provider Demographics
NPI:1255029039
Name:SIMMONS, KIDIMI (LPN)
Entity type:Individual
Prefix:
First Name:KIDIMI
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22850 LAFOURCHE LN
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6979
Mailing Address - Country:US
Mailing Address - Phone:225-348-8068
Mailing Address - Fax:
Practice Address - Street 1:22850 LAFOURCHE LN
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-6979
Practice Address - Country:US
Practice Address - Phone:225-348-8068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20120400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse