Provider Demographics
NPI:1548403876
Name:SIMPSON, BRENDA S (FNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:
Practice Address - Street 1:411 N MCCROSKEY ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9330
Practice Address - Country:US
Practice Address - Phone:417-269-2227
Practice Address - Fax:417-269-2235
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1548403876Medicaid
MO148380004Medicare PIN
MO1548403876Medicaid