Provider Demographics
NPI:1033626361
Name:SIMPSON, JENNIFER LYNN (NP -BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:NP -BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 RANDOLPH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-3047
Mailing Address - Country:US
Mailing Address - Phone:540-731-3200
Mailing Address - Fax:
Practice Address - Street 1:701 RANDOLPH ST STE 120
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-3047
Practice Address - Country:US
Practice Address - Phone:540-731-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017143827363LF0000X
VA0024174684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily