Healthcare Provider Details

I. General information

NPI: 1316962038
Provider Name (Legal Business Name): KATHRYN MARY SIMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 NORTH BLVD W STE 1
DAVENPORT FL
33837-8983
US

IV. Provider business mailing address

2380 NORTH BLVD W STE 1
DAVENPORT FL
33837-8983
US

V. Phone/Fax

Practice location:
  • Phone: 863-422-8574
  • Fax: 863-422-7251
Mailing address:
  • Phone: 863-422-8574
  • Fax: 863-422-7251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME122966
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG7884
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: