Provider Demographics
NPI:1609834126
Name:SIMPSON, JIM W (CRNA)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:W
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:JIMMIE
Other - Middle Name:W
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6000 ELDORADO PKWY
Mailing Address - Street 2:APT 913
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3573
Mailing Address - Country:US
Mailing Address - Phone:816-810-3820
Mailing Address - Fax:
Practice Address - Street 1:6000 ELDORADO PKWY
Practice Address - Street 2:APT 913
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3573
Practice Address - Country:US
Practice Address - Phone:816-810-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK249367500000X
MO069978367500000X
TXAP128118367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1609834126Medicaid
S55000003Medicare PIN
MO1609834126Medicaid