Healthcare Provider Details

I. General information

NPI: 1659156248
Provider Name (Legal Business Name): KATIANA LESLIE CAREY-SIMMS CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

IV. Provider business mailing address

214 KENTUCKY ST # A
VALLEJO CA
94590-5038
US

V. Phone/Fax

Practice location:
  • Phone: 530-204-5317
  • Fax:
Mailing address:
  • Phone: 510-847-5836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95026214
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: