Provider Demographics
NPI:1265659247
Name:SIMMONS, KENYAWN JUDEA (FNP-C)
Entity type:Individual
Prefix:
First Name:KENYAWN
Middle Name:JUDEA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 KATY FORT BEND RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3888
Mailing Address - Country:US
Mailing Address - Phone:707-694-0095
Mailing Address - Fax:
Practice Address - Street 1:1420 KATY FORT BEND RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3888
Practice Address - Country:US
Practice Address - Phone:707-694-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1159164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2723673Medicaid