Provider Demographics
NPI:1124224399
Name:SIMPSON, VICKI SUSAN (CPNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:SUSAN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 W HEARN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-5734
Mailing Address - Country:US
Mailing Address - Phone:602-242-5121
Mailing Address - Fax:602-242-6945
Practice Address - Street 1:6702 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1101
Practice Address - Country:US
Practice Address - Phone:602-242-5121
Practice Address - Fax:602-242-6945
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN036720363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics