Provider Demographics
NPI:1477033355
Name:SIMPSON, MIKAYLA SHEA
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:SHEA
Last Name:SIMPSON
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 1:4359 STATE ROUTE 141
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-8769
Mailing Address - Country:US
Mailing Address - Phone:606-615-5545
Mailing Address - Fax:
Practice Address - Street 1:3501 COURT ST
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129-1011
Practice Address - Country:US
Practice Address - Phone:606-739-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist