Provider Demographics
NPI:1811282643
Name:SIMPSON, KENDRA ELYSE (MD)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:ELYSE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 LAZARD ST
Mailing Address - Street 2:
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-2309
Mailing Address - Country:US
Mailing Address - Phone:830-330-0293
Mailing Address - Fax:
Practice Address - Street 1:910 BLACKFORD STREET
Practice Address - Street 2:T.C. THOMPSON CHILDREN'S HOSPITAL
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics