Provider Demographics
NPI:1518040831
Name:SIMPSON, JENNIFER L (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6046
Mailing Address - Country:US
Mailing Address - Phone:704-334-7311
Mailing Address - Fax:704-335-9790
Practice Address - Street 1:1900 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6046
Practice Address - Country:US
Practice Address - Phone:704-334-7311
Practice Address - Fax:704-335-9790
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78880363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP67104Medicare UPIN