Provider Demographics
NPI:1972734002
Name:SIMO, MARCEL (ARNP)
Entity Type:Individual
Prefix:
First Name:MARCEL
Middle Name:
Last Name:SIMO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 HAMPTON WAY STE 8
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8885
Mailing Address - Country:US
Mailing Address - Phone:859-825-6872
Mailing Address - Fax:859-201-1449
Practice Address - Street 1:519 HAMPTON WAY STE 8
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8885
Practice Address - Country:US
Practice Address - Phone:859-825-6872
Practice Address - Fax:859-201-1449
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006066363LP0808X
KY6066P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1120228OtherRN LICENSE NUMBER
KY6066POtherARNP LICENSE NUMBER