Provider Demographics
NPI:1538311741
Name:SIMPSON, MISTY WAYNE (RN, MSN, RNFA, ACNP-)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:WAYNE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RN, MSN, RNFA, ACNP-
Other - Prefix:MRS
Other - First Name:MISTY
Other - Middle Name:WAYNE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3020 NADAR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6792
Mailing Address - Country:US
Mailing Address - Phone:972-841-6131
Mailing Address - Fax:
Practice Address - Street 1:1901 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2220
Practice Address - Country:US
Practice Address - Phone:972-579-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686711363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX293197YKY6Medicare PIN
TX293197YMNTMedicare PIN