Healthcare Provider Details

I. General information

NPI: 1356387872
Provider Name (Legal Business Name): KELLY H. SIMPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY A. HETHERINGTON

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MEDICAL PARKWAY BLDG. B #220
CEDAR PARK TX
78613-7464
US

IV. Provider business mailing address

6210 E HWY 290
AUSTIN TX
78723-1142
US

V. Phone/Fax

Practice location:
  • Phone: 512-260-1581
  • Fax: 512-528-7940
Mailing address:
  • Phone: 512-483-9596
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL25051
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberN2565
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: