MEDICARE: TYSHAY JOY SIMPSON

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	106S00000X	Behavior Technician		NC

General Provider Information

NPI Number	:	1184579666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYSHAY JOY SIMPSON

Provider Business Mailing Address
First Line	:	208 HASTINGS LN
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 HASTINGS LN
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3324
Country	:	US
Telephone Number	:	252-621-1366
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ TYSHAY JOY SIMPSON ” Practice Location

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