Provider Demographics
NPI:1750332219
Name:SIMPSON, RANDY (PA)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6401 PATTERSON PKWY
Mailing Address - Street 2:PO BOX 1107
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-5701
Mailing Address - Country:US
Mailing Address - Phone:620-442-2500
Mailing Address - Fax:620-441-5953
Practice Address - Street 1:6401 PATTERSON PKWY
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-5701
Practice Address - Country:US
Practice Address - Phone:620-442-2500
Practice Address - Fax:620-441-5953
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant