Healthcare Provider Details

I. General information

NPI: 1871995621
Provider Name (Legal Business Name): KIMBERLY RENEE SIMMONS-GILREATH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 04/19/2020
Certification Date: 04/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 NW 7TH AVE STE 300
MIAMI FL
33136-1112
US

IV. Provider business mailing address

446 MORGAN ST
CINCINNATI OH
45206-2348
US

V. Phone/Fax

Practice location:
  • Phone: 305-902-6347
  • Fax: 727-306-8033
Mailing address:
  • Phone: 513-834-7063
  • Fax: 513-873-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP16382
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.16382-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: