Healthcare Provider Details

I. General information

NPI: 1508695693
Provider Name (Legal Business Name): ELIZABETH CLARE SIMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NATIONWIDE DR
LYNCHBURG VA
24502-4272
US

IV. Provider business mailing address

319 WESTOVER BLVD
LYNCHBURG VA
24501-3639
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3908
  • Fax:
Mailing address:
  • Phone: 619-550-9669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010410
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: