Provider Demographics
NPI:1831468305
Name:SIMPSON, JACKIE DENISE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:DENISE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 E WOODROW WILSON AVE
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5116
Mailing Address - Country:US
Mailing Address - Phone:601-362-4471
Mailing Address - Fax:601-364-1389
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-364-1389
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR861533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02089530Medicaid
MS292438YJ5DMedicare PIN