Provider Demographics
NPI:1538822523
Name:SIMPSON, KAYSIE DANIELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KAYSIE
Middle Name:DANIELLE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:KAYSIE
Other - Middle Name:DANIELLE
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-6113
Mailing Address - Country:US
Mailing Address - Phone:918-714-3795
Mailing Address - Fax:
Practice Address - Street 1:101 S MOORE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5091
Practice Address - Country:US
Practice Address - Phone:918-342-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKP0069796164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse