Provider Demographics
NPI:1366675910
Name:SYMMONDS, CHARISSE NICOLE (DO)
Entity type:Individual
Prefix:
First Name:CHARISSE
Middle Name:NICOLE
Last Name:SYMMONDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 12TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2589
Mailing Address - Country:US
Mailing Address - Phone:620-342-2521
Mailing Address - Fax:620-342-6520
Practice Address - Street 1:1301 W 12TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2589
Practice Address - Country:US
Practice Address - Phone:620-342-2521
Practice Address - Fax:620-342-6520
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-37264207R00000X, 207R00000X
FLUO2871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine