Provider Demographics
NPI:1801539424
Name:SIMMONS, KYLE (IDHS, IDEP)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:IDHS, IDEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13411 HILLIARD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-5635
Mailing Address - Country:US
Mailing Address - Phone:281-464-4611
Mailing Address - Fax:281-464-4625
Practice Address - Street 1:13411 HILLIARD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-5635
Practice Address - Country:US
Practice Address - Phone:281-464-4611
Practice Address - Fax:281-464-4625
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman