Provider Demographics
NPI:1487939781
Name:SIMMS, KELLY A (ND)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:SIMMS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 W BELDEN AVE # 3F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3110
Mailing Address - Country:US
Mailing Address - Phone:480-270-2145
Mailing Address - Fax:
Practice Address - Street 1:1901 N CLYBOURN AVE STE 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6808
Practice Address - Country:US
Practice Address - Phone:773-472-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099-0071912175F00000X
IL164.006298133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered