Provider Demographics
NPI:1477939791
Name:SIMPSON, EMILY R (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:K
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 2330
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-2330
Mailing Address - Country:US
Mailing Address - Phone:843-837-4400
Mailing Address - Fax:843-837-4440
Practice Address - Street 1:350 FORDING ISLAND RD STE 100
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5168
Practice Address - Country:US
Practice Address - Phone:843-837-4400
Practice Address - Fax:843-837-4440
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003167383Medicaid