Provider Demographics
NPI:1053843607
Name:SIMPSOM, KENDRA P
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:P
Last Name:SIMPSOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5717 LITTLE ELM LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2364
Mailing Address - Country:US
Mailing Address - Phone:501-256-9070
Mailing Address - Fax:
Practice Address - Street 1:5717 LITTLE ELM LN
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2364
Practice Address - Country:US
Practice Address - Phone:501-256-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12362347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker