Basic Information
Provider Information
NPI: 1003002908
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIMPSON
FirstName: DAVAUGHNDA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 251970
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722251970
CountryCode: US
TelephoneNumber: 5016668686
FaxNumber: 5016606830
Practice Location
Address1: 5905 FOREST PL
Address2: SUITE 100
City: LITTLE ROCK
State: AR
PostalCode: 722075244
CountryCode: US
TelephoneNumber: 5016664949
FaxNumber: 5016606840
Other Information
ProviderEnumerationDate: 09/25/2007
LastUpdateDate: 09/25/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X  Y Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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