Provider Demographics
NPI:1891770723
Name:SIMMERS, KYLE EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:EDWIN
Last Name:SIMMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E. HIGHWAY 20
Mailing Address - Street 2:PEDIATRIC DEPARTMENT
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578
Mailing Address - Country:US
Mailing Address - Phone:850-897-4400
Mailing Address - Fax:850-897-0623
Practice Address - Street 1:2001 E HIGHWAY 20
Practice Address - Street 2:PEDIATRIC DEPARTMENT
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8826
Practice Address - Country:US
Practice Address - Phone:850-897-4400
Practice Address - Fax:850-897-0623
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48088OtherBCBSFL
FL270268100Medicaid
I15346Medicare UPIN
FL48088OtherBCBSFL