Individual
KELLI J SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
420 DELAWARE STREET SOUTHEAST, MAYO MAIL CODE 450, MINNEAPOLIS, MN 55455
(612) 626-5919
(612) 625-4406
Mailing address
1570 EUSTIS ST, APARTMENT 133, LAUDERDALE, MN 55108-1260
(651) 646-0172
Taxonomy
Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
093545
MO
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
R183718-8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427483300
—
MO
01
—
P00104707
RR MEDICARE
MO
Enumeration date
06/01/2006
Last updated
02/17/2010
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