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NPI Code Detail

MEDICARE: MRS. KELLY CARTER SIMCOX FNP-BC

MEDICARE: MRS. KELLY CARTER SIMCOX FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner15152TN

General Provider Information

NPI Number : 1003122755
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY CARTER SIMCOX FNP-BC
Provider Business Mailing Address
First Line : 1021 W OAKLAND AVE STE 310
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-2192
Country : US
Telephone Number : 423-952-2111
Fax Number :
Provider Business Practice Location Address
First Line : 271 MEDICAL PARK BLVD
Second Line :
City : BRISTOL
State : TN
Zip : 37620-7455
Country : US
Telephone Number : 423-274-8600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2010
Last Update Date : 03/10/2026

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Directions to “ MRS. KELLY CARTER SIMCOX FNP-BC” Practice Location

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