Provider Demographics
NPI:1003122755
Name:SIMCOX, KELLY CARTER (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CARTER
Last Name:SIMCOX
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MIDWAY MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1664
Mailing Address - Country:US
Mailing Address - Phone:423-844-6515
Mailing Address - Fax:423-652-2590
Practice Address - Street 1:212 MIDWAY MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1664
Practice Address - Country:US
Practice Address - Phone:423-844-6515
Practice Address - Fax:423-652-2590
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily