Provider Demographics
NPI:1639372063
Name:SIMPSON, BETSY J (PA-C)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:J
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-944-9800
Mailing Address - Fax:
Practice Address - Street 1:1115 RONALD REAGAN PKWY STE 329
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6914
Practice Address - Country:US
Practice Address - Phone:317-944-9800
Practice Address - Fax:317-278-6523
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2020-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3639363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ223599Medicaid
AZP00624818OtherRAILROAD MEDICARE
AZ223599Medicaid