Healthcare Provider Details

I. General information

NPI: 1437541661
Provider Name (Legal Business Name): KAY LYNN SIMONS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E JEFFERSON ST
PHOENIX AZ
85034-2295
US

IV. Provider business mailing address

12633 N 25TH AVE
PHOENIX AZ
85029-2533
US

V. Phone/Fax

Practice location:
  • Phone: 602-251-0650
  • Fax: 602-396-1210
Mailing address:
  • Phone: 602-882-5725
  • Fax: 602-396-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN083805
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: