MEDICARE: KELSEY ELIZABETH SIMMONS 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	207Q00000X	Family Medicine Physician	OS025208	PA
2	207Q00000X	Family Medicine Physician	217198	NC

General Provider Information

NPI Number	:	1831545383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY ELIZABETH SIMMONS D.O.

Provider Business Mailing Address
First Line	:	5221 PARAMOUNT PKWY STE 220
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-5490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1249 CHICKEN FOOT RD
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-7525
Country	:	US
Telephone Number	:	910-423-1278
Fax Number	:	910-423-2547

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

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	12/26/2025

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