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General NPI Number Information
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NPI Number | 1134742885
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Entity Type | Individual
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Provider Name | KENNETH DALE SIMMONS III CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 755 N 11TH ST STE P3600
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City | BEAUMONT
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State | TX
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Zip | 77702-1515
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Country | US
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Telephone | 409-838-5214
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Fax |
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Provider Business Mailing Address
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Address Line | 3895 CYPRESS POINT DR
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City | BEAUMONT
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State | TX
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Zip | 77707-5430
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Country | US
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Telephone | 409-673-6574
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 131500
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License Number State | FL
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