Provider Demographics
NPI:1912618448
Name:SIMMONS, KAYLEE ANNE (PA)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:ANNE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 LYMAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-9539
Mailing Address - Country:US
Mailing Address - Phone:907-315-2388
Mailing Address - Fax:
Practice Address - Street 1:35 LYMAN LAKE RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-9539
Practice Address - Country:US
Practice Address - Phone:907-315-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant