Basic Information
| Provider Information | |||||||||
| NPI: | 1366877250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMPSON | ||||||||
| FirstName: | KOURTNEY | ||||||||
| MiddleName: | ADELE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | CMR 427 BOX 2614 | ||||||||
| Address2: | |||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 096300027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1463698623 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | UNIT 31401 | ||||||||
| Address2: | |||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 096301401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707988614 | ||||||||
| FaxNumber: | 1463698623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2013 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 9756 | TN | Y | Dental Providers | Dentist |
No ID Information.