Active NPI
Krista Simmons, LCSW
- Clinical Social Worker
- Fort Walton Beach, FL
National Provider Identifier
1669957791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW15407
- Practice address
- 1992 Lewis Turner Blvd Ste 1067
Fort Walton Beach, FL 32547-1255 - Phone
- (540) 353-3280
- NPI assigned
- Sep 25, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904009627 | VA | |
| Clinical Social Worker | 1041C0700X | 6656 | TN | |
| Clinical Social Worker | 1041C0700X | SW15407 | FL | Primary |
Addresses
Primary practice location
1992 Lewis Turner Blvd Ste 1067
Fort Walton Beach, FL 32547-1255
Mailing address
1992 Lewis Turner Blvd Ste 1067
Fort Walton Beach, FL 32547-1255
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6656 | Other | TN | LCSW |
| SW15407 | Other | FL | LCSW |
| 0904009627 | Other | VA | LCSW |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW15407 | FL | MD | Clinical Social Worker |
| 0904009627 | VA | MD | Clinical Social Worker |
| 6656 | TN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729728000000",
"number": "1669957791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1992 LEWIS TURNER BLVD STE 1067",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325471255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1992 LEWIS TURNER BLVD STE 1067",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325471255",
"telephone_number": "540-353-3280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMMONS",
"first_name": "KRISTA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-25",
"last_updated": "2024-10-24",
"certification_date": "2024-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904009627",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "6656",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW15407",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW",
"identifier": "6656",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW",
"identifier": "SW15407",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LCSW",
"identifier": "0904009627",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.