Healthcare Provider Details

I. General information

NPI: 1891202628
Provider Name (Legal Business Name): REGINA G SIMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ADVANCED TECHNOLOGY DR
DUFFIELD VA
24244-5126
US

IV. Provider business mailing address

PO BOX 9
KINGSPORT TN
37662-0009
US

V. Phone/Fax

Practice location:
  • Phone: 276-431-2648
  • Fax:
Mailing address:
  • Phone: 423-857-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23647
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175703
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: