Provider Demographics
NPI:1548287246
Name:SIMMONS, KRISTI ANN (ATC, MS PA-C)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:ANN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:ATC, MS PA-C
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:ANN
Other - Last Name:REPPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, MS PA-C
Mailing Address - Street 1:219 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2355
Mailing Address - Country:US
Mailing Address - Phone:734-241-0366
Mailing Address - Fax:734-241-0680
Practice Address - Street 1:219 W FRONT ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2355
Practice Address - Country:US
Practice Address - Phone:734-241-0366
Practice Address - Fax:734-241-0680
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant