Healthcare Provider Details

I. General information

NPI: 1477497576
Provider Name (Legal Business Name): MARDISHA STELLA SIMPSON ADN,BS,RHIT,NP,MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 PEARL PARK WAY
CHARLOTTE NC
28204-0073
US

IV. Provider business mailing address

5023 RIVERDALE DR
CHARLOTTE NC
28273-8912
US

V. Phone/Fax

Practice location:
  • Phone: 704-907-9921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number940389678
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4202053
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4104801506
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberSI9848238
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number36630
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number519252368
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number13871770
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16507430
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: