1194991315 NPI number — MRS. KARI ANN SIMPSON FNP-BC

Table of content: MRS. KARI ANN SIMPSON FNP-BC (NPI 1194991315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194991315 NPI number — MRS. KARI ANN SIMPSON FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMPSON
Provider First Name:
KARI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VOREL
Provider Other First Name:
KARI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194991315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 SILVER CROSS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW LENOX
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60451-9509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-300-1100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12251 S 80TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALOS HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60463-1256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-257-1111
Provider Business Practice Location Address Fax Number:
630-257-1115
Provider Enumeration Date:
05/07/2008

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: 363LF0000X , with the licence number:  209.005769 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: F400353282 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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