Healthcare Provider Details

I. General information

NPI: 1922384304
Provider Name (Legal Business Name): KELLY LEIGHANN SIMERMAN NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 HAL GREER BLVD
HUNTINGTON WV
25701-3800
US

IV. Provider business mailing address

1340 HAL GREER BLVD
HUNTINGTON WV
25701-3800
US

V. Phone/Fax

Practice location:
  • Phone: 304-526-2370
  • Fax: 304-526-6303
Mailing address:
  • Phone: 304-526-2370
  • Fax: 304-526-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number46147
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: