Provider Demographics
NPI:1740048644
Name:SIMPSON, SPENCER ANDREW (APRN-CNP)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:ANDREW
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4592 S DENISON AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9224
Mailing Address - Country:US
Mailing Address - Phone:208-514-6934
Mailing Address - Fax:
Practice Address - Street 1:4592 S DENISON AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9224
Practice Address - Country:US
Practice Address - Phone:208-514-6934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID78896363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner