Provider Demographics
NPI:1912777640
Name:SIMPSON, JENNA JO
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:JO
Last Name:SIMPSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4187 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5576
Mailing Address - Country:US
Mailing Address - Phone:513-444-0480
Mailing Address - Fax:
Practice Address - Street 1:9100 CENTRE POINTE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4846
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.009021RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant