Provider Demographics
NPI:1487355798
Name:SIMCOE, CLARK (RDN)
Entity type:Individual
Prefix:
First Name:CLARK
Middle Name:
Last Name:SIMCOE
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 COLLIERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-7230
Mailing Address - Country:US
Mailing Address - Phone:225-485-0066
Mailing Address - Fax:
Practice Address - Street 1:204 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2116
Practice Address - Country:US
Practice Address - Phone:225-485-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered