Healthcare Provider Details

I. General information

NPI: 1750332219
Provider Name (Legal Business Name): RANDY SIMPSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 PATTERSON PKWY
ARKANSAS CITY KS
67005-5701
US

IV. Provider business mailing address

6401 PATTERSON PKWY PO BOX 1107
ARKANSAS CITY KS
67005-5701
US

V. Phone/Fax

Practice location:
  • Phone: 620-442-2500
  • Fax: 620-441-5953
Mailing address:
  • Phone: 620-442-2500
  • Fax: 620-441-5953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-00588
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: