Provider Demographics
NPI:1851075071
Name:SIMPSON, DUSTIN MICHAEL I (FNP)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:MICHAEL
Last Name:SIMPSON
Suffix:I
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 IRON WORKS RD
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752
Mailing Address - Country:US
Mailing Address - Phone:865-279-1671
Mailing Address - Fax:
Practice Address - Street 1:473 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1133
Practice Address - Country:US
Practice Address - Phone:606-302-5116
Practice Address - Fax:606-302-5117
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily