Provider Demographics
NPI:1285822148
Name:SIMPSON, TEMPLE WALKER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TEMPLE
Middle Name:WALKER
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 PARSONS RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3348
Mailing Address - Country:US
Mailing Address - Phone:854-201-3636
Mailing Address - Fax:854-220-0121
Practice Address - Street 1:204 PARSONS RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3348
Practice Address - Country:US
Practice Address - Phone:854-220-0120
Practice Address - Fax:854-220-0121
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1247363A00000X
SC1247363AM0700X
SCLL1247363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0920PAMedicaid
SC0920PAMedicaid
SC0920PAMedicaid