Healthcare Provider Details

I. General information

NPI: 1003724519
Provider Name (Legal Business Name): MARISOL SIMS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 1ST INFANTRY DIVISION RD
FORT KNOX KY
40121-5210
US

IV. Provider business mailing address

968 1ST INFANTRY DIVISION RD
FORT KNOX KY
40121-5210
US

V. Phone/Fax

Practice location:
  • Phone: 502-626-8303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: