Healthcare Provider Details

I. General information

NPI: 1336416783
Provider Name (Legal Business Name): KERI MEGAN SIMMONS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 24TH AVE S SUITE 700
MINNEAPOLIS MN
55454-1455
US

IV. Provider business mailing address

2545 32ND AVE S
MINNEAPOLIS MN
55406-1639
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-2450
  • Fax:
Mailing address:
  • Phone: 651-592-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR1722549
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: