Healthcare Provider Details

I. General information

NPI: 1508447087
Provider Name (Legal Business Name): KADE SIMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MAR WALT DR # 32547
FORT WALTON BEACH FL
32547-6708
US

IV. Provider business mailing address

5001 HARDY ST
HATTIESBURG MS
39402-1308
US

V. Phone/Fax

Practice location:
  • Phone: 850-862-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS20795
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: