Healthcare Provider Details

I. General information

NPI: 1538005657
Provider Name (Legal Business Name): LAKATERIA SIMMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8174 LAS VEGAS BLVD S STE 101
LAS VEGAS NV
89123-1030
US

IV. Provider business mailing address

4200 HARRIS AVE
LAS VEGAS NV
89110-2224
US

V. Phone/Fax

Practice location:
  • Phone: 702-720-3812
  • Fax:
Mailing address:
  • Phone: 904-430-8539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: