1275511321 NPI number — MRS. VICKEY L SIMMONS C.R.N.A.

Table of content: MRS. VICKEY L SIMMONS C.R.N.A. (NPI 1275511321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275511321 NPI number — MRS. VICKEY L SIMMONS C.R.N.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMONS
Provider First Name:
VICKEY
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275511321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 S SANTA FE AVE
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401-4190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-827-2238
Provider Business Mailing Address Fax Number:
785-827-1684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 S SANTA FE AVE
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401-4190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-827-2238
Provider Business Practice Location Address Fax Number:
785-827-1684
Provider Enumeration Date:
01/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  55100 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200002330D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145962 . This is a "BCBS KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 20002330B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".