Provider Demographics
NPI:1053388744
Name:SIMPSON, KELLEY K (PA C)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:K
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:175 LANCASTER BLVD
Mailing Address - Street 2:PO BOX 2028
Mailing Address - City:MECHANICBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055
Mailing Address - Country:US
Mailing Address - Phone:717-691-3755
Mailing Address - Fax:717-691-3834
Practice Address - Street 1:175 LANCASTER BLVD
Practice Address - Street 2:
Practice Address - City:MECHANICBURG
Practice Address - State:PA
Practice Address - Zip Code:17055
Practice Address - Country:US
Practice Address - Phone:717-691-3755
Practice Address - Fax:717-691-3834
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052283363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011422800001Medicaid
PA096368KCUMedicare PIN
Q57837Medicare UPIN