Provider Demographics
NPI:1679207419
Name:SIMPSON, KIANA JANAY
Entity Type:Individual
Prefix:
First Name:KIANA
Middle Name:JANAY
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5075 MORGANTON RD
Mailing Address - Street 2:STE 10C #1377
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1534
Mailing Address - Country:US
Mailing Address - Phone:910-446-5520
Mailing Address - Fax:
Practice Address - Street 1:4801 GLENWOOD AVENUE
Practice Address - Street 2:SUITE 200 PMB 1100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:910-446-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC88-2847783OtherPHLEBOTOMY