Provider Demographics
NPI:1295442358
Name:SIMMONS, KAITLYN E (DNP, FNP-BC, RN)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:E
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:DNP, FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1330
Mailing Address - Country:US
Mailing Address - Phone:203-444-2031
Mailing Address - Fax:
Practice Address - Street 1:9 N BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2527
Practice Address - Country:US
Practice Address - Phone:610-543-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN676866363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner