Provider Demographics
NPI:1912131913
Name:SIMMONS, KIMBERLY B (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:B
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JB
Other - Last Name:BURROWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:3400 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116
Practice Address - Country:US
Practice Address - Phone:206-320-3399
Practice Address - Fax:206-320-5506
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60303007207Q00000X
NC156617390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1912131913Medicaid