Provider Demographics
NPI:1710646773
Name:SIMPSON, AMANDA LIN (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LIN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14762 E FIELDSTONE DR N
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-1805
Mailing Address - Country:US
Mailing Address - Phone:918-430-5567
Mailing Address - Fax:
Practice Address - Street 1:12162 S WACO AVE
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-7403
Practice Address - Country:US
Practice Address - Phone:918-304-8119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202516363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner