Provider Demographics
NPI:1548719297
Name:SIMMONS, KYMBERLY BROOKE (CLC, ALC)
Entity type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:BROOKE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CLC, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 POLK AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-6942
Mailing Address - Country:US
Mailing Address - Phone:407-221-4475
Mailing Address - Fax:
Practice Address - Street 1:1325 POLK AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-6942
Practice Address - Country:US
Practice Address - Phone:407-221-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN