Basic Information
| Provider Information | |||||||||
| NPI: | 1891770723 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMERS | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | EDWIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 E. HIGHWAY 20 | ||||||||
| Address2: | PEDIATRIC DEPARTMENT | ||||||||
| City: | NICEVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508974400 | ||||||||
| FaxNumber: | 8508970623 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 E HIGHWAY 20 | ||||||||
| Address2: | PEDIATRIC DEPARTMENT | ||||||||
| City: | NICEVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325788826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508974400 | ||||||||
| FaxNumber: | 8508970623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 01/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME86100 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 48088 | 01 | FL | BCBSFL | OTHER | 270268100 | 05 | FL | MEDICAID |