Provider Demographics
NPI:1982904777
Name:SIMPSON, KELLY S (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 HWY 22 EAST
Mailing Address - Street 2:TRIAD HEALTH SYSTEMS
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359
Mailing Address - Country:US
Mailing Address - Phone:502-547-1010
Mailing Address - Fax:859-567-1253
Practice Address - Street 1:1005 HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-9041
Practice Address - Country:US
Practice Address - Phone:502-547-1010
Practice Address - Fax:859-567-1253
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6619P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100167220Medicaid