Provider Demographics
NPI:1528350097
Name:SIMPSON, KEVIN M
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BIG HORN ST
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-2342
Mailing Address - Country:US
Mailing Address - Phone:307-921-0592
Mailing Address - Fax:
Practice Address - Street 1:641 WARREN ST
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-2619
Practice Address - Country:US
Practice Address - Phone:307-864-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator