Provider Demographics
NPI:1003530098
Name:SIMPSON, TYNETTA QUNIQUE (APRN)
Entity Type:Individual
Prefix:
First Name:TYNETTA
Middle Name:QUNIQUE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TYNETTA
Other - Middle Name:QUNIQUE
Other - Last Name:BEAMON-SIMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:6628 CROSS OAK CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-0400
Mailing Address - Country:US
Mailing Address - Phone:901-672-3109
Mailing Address - Fax:
Practice Address - Street 1:10710 OLD HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-3587
Practice Address - Country:US
Practice Address - Phone:731-658-6113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN193503163W00000X
TN32489363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse