Healthcare Provider Details

I. General information

NPI: 1699444000
Provider Name (Legal Business Name): JESSICA MITCHELL SIMPKINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 E MAIN ST
EASLEY SC
29640-3791
US

IV. Provider business mailing address

105 VINECREST CT # 300
GREENWOOD SC
29646-8031
US

V. Phone/Fax

Practice location:
  • Phone: 864-306-8533
  • Fax:
Mailing address:
  • Phone: 864-223-6625
  • Fax: 864-223-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25014
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: