MEDICARE: MRS. KENDRA P SIMPSOM

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
1	347E00000X	Transportation Broker	12362	AR

General Provider Information

NPI Number	:	1053843607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENDRA P SIMPSOM

Provider Business Mailing Address
First Line	:	5717 LITTLE ELM LN
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2364
Country	:	US
Telephone Number	:	501-256-9070
Fax Number	:

Provider Business Practice Location Address
First Line	:	5717 LITTLE ELM LN
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2364
Country	:	US
Telephone Number	:	501-256-9070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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