Healthcare Provider Details

I. General information

NPI: 1912888132
Provider Name (Legal Business Name): KRISTEN SIMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 KENTUCKY AVE
PADUCAH KY
42003-3813
US

IV. Provider business mailing address

3715 US HIGHWAY 68 W
BENTON KY
42025-6684
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3894
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: