Provider Demographics
NPI:1093952137
Name:SIMPSON, KATHLEEN M (CNS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44907 NITCHE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-8889
Mailing Address - Country:US
Mailing Address - Phone:218-346-4198
Mailing Address - Fax:
Practice Address - Street 1:126 E ALCOTT AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2903
Practice Address - Country:US
Practice Address - Phone:218-739-1725
Practice Address - Fax:218-736-6980
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 069715-4364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent