| Doctor Name: | KIMBERLY ANN SIMON |
| NPI Number: | 1154798189 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MMS, PA-C |
| License Number: | 085.005344 |
| Business Practice Address: | 375 N Wall St Suite P640 Kankakee, IL - 609013483 |
| Business Phone Number: | 8159320911 |
| Business Fax Number: | 8159320631 |
| Mailing Address: | 375 N Wall St, Suite P640 KANKAKEE |
| State: | IL |
| Postal Code: | 609013483 |
| Phone Number: | 8159320911 |
| Fax Number: | 8159320631 |
| NPI Enumeration Date: | 08/25/2015 |
| NPI Last Update Date: | 08/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 085.005344 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |