MEDICARE: AUDREY SIMPSON MBA

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	172V00000X	Community Health Worker
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1346070687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY SIMPSON MBA

Provider Business Mailing Address
First Line	:	7406 DEERWOOD AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-2731
Country	:	US
Telephone Number	:	510-396-5172
Fax Number	:

Provider Business Practice Location Address
First Line	:	7406 DEERWOOD AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-2731
Country	:	US
Telephone Number	:	510-396-5172
Fax Number	:

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

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	08/02/2024

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