Provider Demographics
NPI:1346429602
Name:SIMPSON, JACQUELINE (PMHNP-BC, PNP-BC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PMHNP-BC, PNP-BC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:SIMPSON-DUNNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP-BC, PNP-BC
Mailing Address - Street 1:246 POST RD E FL 2
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3615
Mailing Address - Country:US
Mailing Address - Phone:475-214-8233
Mailing Address - Fax:203-547-7724
Practice Address - Street 1:14 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06907-2401
Practice Address - Country:US
Practice Address - Phone:475-214-8233
Practice Address - Fax:203-547-7724
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003260363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003260OtherAPRN
CT003260Medicaid