Healthcare Provider Details

I. General information

NPI: 1821048679
Provider Name (Legal Business Name): LOUISE KELLY SIMMS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD
LEXINGTON KY
40504-3516
US

IV. Provider business mailing address

1113B LINCOLN PARK RD
SPRINGFIELD KY
40069-9573
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6371
  • Fax: 859-257-3585
Mailing address:
  • Phone: 859-481-9008
  • Fax: 859-481-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA926
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA926
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001940
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA926
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: