Healthcare Provider Details

I. General information

NPI: 1275405748
Provider Name (Legal Business Name): MANDIE SIMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 DIXIE HWY STE 135
LOUISVILLE KY
40258-3952
US

IV. Provider business mailing address

7951 SHOAL CREEK BLVD STE 300
AUSTIN TX
78757-7582
US

V. Phone/Fax

Practice location:
  • Phone: 502-791-8700
  • Fax: 502-742-8523
Mailing address:
  • Phone: 512-584-8404
  • Fax: 502-742-8523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4045954
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1170615
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: