=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033593447
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SETH TRAVIS SIMPSON APRN-NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2015
-----------------------------------------------------
Last Update Date | 05/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 ABRAHAM FLEXNER WAY STE 1004
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-589-3173
-----------------------------------------------------
Fax | 502-589-6751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 E LIBERTY ST STE 800
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-589-3173
-----------------------------------------------------
Fax | 502-589-6751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 3009411
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------