Healthcare Provider Details

I. General information

NPI: 1104751452
Provider Name (Legal Business Name): AVERY CORIN SIMPSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 INNOVATION DR STE 3136
YORK PA
17408-8815
US

IV. Provider business mailing address

1703 INNOVATION DR STE 3136
YORK PA
17408-8815
US

V. Phone/Fax

Practice location:
  • Phone: 717-741-3449
  • Fax:
Mailing address:
  • Phone: 717-741-3449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067966
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: