Basic Information
| Provider Information | |||||||||
| NPI: | 1366675910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYMMONDS | ||||||||
| FirstName: | CHARISSE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 W 12TH AVE STE 202 | ||||||||
| Address2: | |||||||||
| City: | EMPORIA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 668012589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203422521 | ||||||||
| FaxNumber: | 6203426520 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W 12TH AVE STE 202 | ||||||||
| Address2: | |||||||||
| City: | EMPORIA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 668012589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203422521 | ||||||||
| FaxNumber: | 6203426520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2009 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 05-37264 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.