1447274816 NPI number — MRS. TRACY LAVON SIMPSON M.P.T.

Table of content: MRS. TRACY LAVON SIMPSON M.P.T. (NPI 1447274816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447274816 NPI number — MRS. TRACY LAVON SIMPSON M.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMPSON
Provider First Name:
TRACY
Provider Middle Name:
LAVON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTO
Provider Other First Name:
TRACY
Provider Other Middle Name:
LAVON
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447274816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22278 NORTHWESTERN PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROMNEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-822-6024
Provider Business Mailing Address Fax Number:
304-822-7989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22278 NORTHWESTERN PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROMNEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-822-6024
Provider Business Practice Location Address Fax Number:
304-822-7989
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  20809 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 001922 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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