Healthcare Provider Details

I. General information

NPI: 1346803467
Provider Name (Legal Business Name): KENDRA SIMONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 W MAIN ST
LIVINGSTON TN
38570-1721
US

IV. Provider business mailing address

PO BOX 1258
WAYNESBORO TN
38485-1258
US

V. Phone/Fax

Practice location:
  • Phone: 931-219-2091
  • Fax:
Mailing address:
  • Phone: 931-253-1110
  • Fax: 256-664-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number25552
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25552
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: