Provider Demographics
NPI:1013452424
Name:SIMPSON, CHRISTIN ALYCE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIN
Middle Name:ALYCE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8122
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-7216
Mailing Address - Fax:314-362-8813
Practice Address - Street 1:4921 PARKVIEW PL FL 7
Practice Address - Street 2:7TH FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7216
Practice Address - Fax:314-362-8813
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009029689363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid