Provider Demographics
NPI:1184048977
Name:SIMPSON, KRYSTAL TAMARA (LPN)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:TAMARA
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52008 KINGS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-6348
Mailing Address - Country:US
Mailing Address - Phone:586-273-7011
Mailing Address - Fax:
Practice Address - Street 1:52008 KINGS POINTE DR
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-6348
Practice Address - Country:US
Practice Address - Phone:586-273-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703112836164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse