Provider Demographics
NPI:1700013315
Name:SIMMONS, AMANDA CORRINE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CORRINE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:CORRINE
Other - Last Name:SPITALNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:STE 395B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-849-3500
Mailing Address - Fax:314-849-4422
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:STE 395B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-849-3500
Practice Address - Fax:314-849-4422
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009013699207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology