=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679699375
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY SIMPSON PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 11/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7700 FLOYD CURL DR 10TH FLOOR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-3902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-575-3817
-----------------------------------------------------
Fax | 210-575-4113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8109 FREDERICKSBURG RD PHYSICIAN PRACTICE SERVICES
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-575-3817
-----------------------------------------------------
Fax | 210-575-4113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA03477
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------