Healthcare Provider Details

I. General information

NPI: 1487939781
Provider Name (Legal Business Name): KELLY A SIMMS N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N CLYBOURN AVE STE 301
CHICAGO IL
60614-6808
US

IV. Provider business mailing address

1317 W BELDEN AVE # 3F
CHICAGO IL
60614-3110
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-0560
  • Fax:
Mailing address:
  • Phone: 480-270-2145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099-0071912
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.006298
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: