Provider Demographics
NPI:1972300069
Name:SIMPSON, JUSTIN LEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:SIMPSON
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 N FAUDREE RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8875
Mailing Address - Country:US
Mailing Address - Phone:432-332-1386
Mailing Address - Fax:
Practice Address - Street 1:3001 N FAUDREE RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8875
Practice Address - Country:US
Practice Address - Phone:432-332-1386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1191512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily