Provider Demographics
NPI:1194435669
Name:KIDD-SIMMONS, TRINA SERENA (TRANSPPRTION PROVIDE)
Entity type:Individual
Prefix:PROF
First Name:TRINA
Middle Name:SERENA
Last Name:KIDD-SIMMONS
Suffix:
Gender:F
Credentials:TRANSPPRTION PROVIDE
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:TRINA KIDD-SIMMONS
Mailing Address - Street 2:131 SCOTT STREET
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320
Mailing Address - Country:US
Mailing Address - Phone:336-580-4866
Mailing Address - Fax:336-347-7030
Practice Address - Street 1:TRINA KIDD-SIMMONS
Practice Address - Street 2:131 SCOTT STREET
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320
Practice Address - Country:US
Practice Address - Phone:336-580-4866
Practice Address - Fax:336-347-7030
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28776506347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle