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General NPI Number Information
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NPI Number | 1477497576
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Entity Type | Individual
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Provider Name | MARDISHA STELLA SIMPSON ADN,BS,RHIT,NP,MD
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Gender | Female
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Dates
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Enumeration Date | 04/17/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 915 PEARL PARK WAY
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City | CHARLOTTE
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State | NC
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Zip | 28204-0073
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Country | US
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Telephone | 704-907-9921
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Fax |
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Provider Business Mailing Address
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Address Line | 5023 RIVERDALE DR
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City | CHARLOTTE
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State | NC
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Zip | 28273-8912
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 940389678
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4202053
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4104801506
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | SI9848238
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 132700000X
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Taxonomy Name | Dietary Manager
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License Number | 36630
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License Number State | NC
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Taxonomy #6
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 519252368
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License Number State | NC
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Taxonomy #7
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 13871770
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License Number State | TN
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Taxonomy #8
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16507430
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License Number State | NC
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