MEDICARE: RHONDA KAYE SIMONS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		MO
2	207Q00000X	Family Medicine Physician	2009006695	MO

General Provider Information

NPI Number	:	1396780367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA KAYE SIMONS D.O.

Provider Business Mailing Address
First Line	:	4240 BLUE RIDGE BLVD
Second Line	:	SUITE 611
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-1713
Country	:	US
Telephone Number	:	816-313-1711
Fax Number	:	816-743-9442

Provider Business Practice Location Address
First Line	:	4240 BLUE RIDGE BLVD
Second Line	:	SUITE 611
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-1713
Country	:	US
Telephone Number	:	816-313-1711
Fax Number	:	816-743-9442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/09/2010

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