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  7. NPI Record 1508492034

KEN SIMMONS
Complete NPI Record 1508492034
Physical Therapist in Altus, OK

NPI Status: Active since March 16, 2020

Contact Information

1100 RANCH RD N
ALTUS, OK
ZIP 73521
Phone: (580) 471-1519

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Enumeration Date
  19. Last Update Date
  20. Provider Gender Code
  21. Healthcare Provider Taxonomy Code 1
  22. Provider License Number 1
  23. Provider License Number State Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Healthcare Provider Taxonomy Code 2
  26. Provider License Number 2
  27. Provider License Number State Code 2
  28. Healthcare Provider Primary Taxonomy Switch 2
  29. Healthcare Provider Taxonomy Code 3
  30. Provider License Number 3
  31. Provider License Number State Code 3
  32. Healthcare Provider Primary Taxonomy Switch 3
  33. Is Sole Proprietor
  34. Healthcare Provider Taxonomy Group 2
  35. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1508492034. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1508492034
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Entity Type Code: 1
The city name in the location address of the provider being identified.
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: KEN
The first name of the provider, if the provider is an individual.
Provider First Line Business Mailing Address: 9501 ANCHUSA TRL
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: AUSTIN
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: TX
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 787362335
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 5124611902
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 5803016069
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1100 RANCH RD N
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: ALTUS
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Provider Business Practice Location Address State Name: OK
Provider Business Practice Location Address Postal Code: 735211031
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 5804711519
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 3/16/2020
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 11/8/2021
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 225100000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 707
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: OK
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Healthcare Provider Primary Taxonomy Switch 1: N
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Healthcare Provider Taxonomy Code 2: 261QP2000X
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider License Number 2: 707
The city name in the location address of the provider being identified.
Provider License Number State Code 2: OK
The State code in the location of the provider being identified.
Healthcare Provider Primary Taxonomy Switch 2: N
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Healthcare Provider Taxonomy Code 3: 225100000X
The country code in the location address of the provider being identified.
Provider License Number 3: 1021988
The telephone number associated with the location address of the provider being identified.
Provider License Number State Code 3: TX
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: Y
The date the provider was assigned a unique identifier (assigned an NPI).
Is Sole Proprietor: Y
The date that a record was last updated or changed.
Healthcare Provider Taxonomy Group 2: 193400000X SINGLE SPECIALTY GROUP
NPI Certification Date: 11/8/2021