Provider Demographics
NPI:1932338803
Name:SIMONS, KARRY ELIZABETH (CSA, L-SA)
Entity Type:Individual
Prefix:MS
First Name:KARRY
Middle Name:ELIZABETH
Last Name:SIMONS
Suffix:
Gender:F
Credentials:CSA, L-SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15201 DERBYSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-2828
Mailing Address - Country:US
Mailing Address - Phone:443-285-3806
Mailing Address - Fax:
Practice Address - Street 1:12741 DARBY BROOK CR
Practice Address - Street 2:SUITE 201
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:443-285-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA0013363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical