Provider Demographics
NPI:1831599836
Name:SIMSPON, BRIENNA
Entity type:Individual
Prefix:
First Name:BRIENNA
Middle Name:
Last Name:SIMSPON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIENNA
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2088 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1024
Mailing Address - Country:US
Mailing Address - Phone:661-860-0697
Mailing Address - Fax:
Practice Address - Street 1:2088 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1024
Practice Address - Country:US
Practice Address - Phone:661-860-0697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT07102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer