=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841221462
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY JANE SIMPSON ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 02/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 LONE OAK ST
-----------------------------------------------------
City | SEGUIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78155-7429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-223-1086
-----------------------------------------------------
Fax | 830-379-6622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 127 LONE OAK ST
-----------------------------------------------------
City | SEGUIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78155-7429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-223-1086
-----------------------------------------------------
Fax | 830-379-6622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 725676
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------