Provider Demographics
NPI:1053905257
Name:SIMPSON, KRISTIN SUMMERLIN (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SUMMERLIN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 SE EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-7765
Mailing Address - Country:US
Mailing Address - Phone:503-869-2319
Mailing Address - Fax:
Practice Address - Street 1:4212 SE EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-7765
Practice Address - Country:US
Practice Address - Phone:503-869-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty