Provider Demographics
NPI:1982714952
Name:SIMONE, KATHRYN C (APRN)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:C
Last Name:SIMONE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 NW SOUTH OUTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3069
Mailing Address - Country:US
Mailing Address - Phone:888-256-3814
Mailing Address - Fax:888-256-3814
Practice Address - Street 1:1100 NW SOUTH OUTER RD STE 200
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3069
Practice Address - Country:US
Practice Address - Phone:888-256-3814
Practice Address - Fax:888-256-3814
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110444363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1982714952Medicaid
NE47037660412Medicaid
IA0585216Medicaid
IA1982714952Medicaid
NE096573030Medicare PIN