Healthcare Provider Details

I. General information

NPI: 1386640340
Provider Name (Legal Business Name): SUSAN DIANE SIMMONS ARNP, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15435 W 134TH PL
OLATHE KS
66062-6135
US

IV. Provider business mailing address

10452 CONSER ST APT 1L
OVERLAND PARK KS
66212-2627
US

V. Phone/Fax

Practice location:
  • Phone: 913-780-0030
  • Fax:
Mailing address:
  • Phone: 913-302-2530
  • Fax: 913-782-2924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44763
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: