Basic Information
Provider Information | |||||||||
NPI: | 1194991315 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SIMPSON | ||||||||
FirstName: | KARI | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VOREL | ||||||||
OtherFirstName: | KARI | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1900 SILVER CROSS BLVD | ||||||||
Address2: |   | ||||||||
City: | NEW LENOX | ||||||||
State: | IL | ||||||||
PostalCode: | 604519509 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8153001100 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 12251 S 80TH AVE | ||||||||
Address2: |   | ||||||||
City: | PALOS HEIGHTS | ||||||||
State: | IL | ||||||||
PostalCode: | 604631256 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6302571111 | ||||||||
FaxNumber: | 6302571115 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/07/2008 | ||||||||
LastUpdateDate: | 09/25/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/25/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.005769 | IL | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | F400353282 | 01 | IL | MEDICARE PTAN | OTHER |