NPIMap

Individual provider Active NPI

Mary Tabatha Simon, FNP

  • Family Nurse Practitioner
  • Easley, SC
National Provider Identifier
1902282270
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
19600 Issued in SC
Practice address
290 Enterprise Dr
Easley, SC 29642-8280
Phone
(864) 365-0290
NPI assigned
Aug 10, 2015
Last updated
Aug 18, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 24643 TN
Family Nurse Practitioner 363LF0000X 19600 SC Primary

Addresses

Primary practice location

290 Enterprise Dr
Easley, SC 29642-8280

Mailing address

3 Professional Park Dr
Ste 21
Johnson City, TN 37604-6529
Phone (423) 434-6300

Other practice location 1

301 Med Tech Pkwy Ste 120
Johnson City, TN 37604-2364
Phone (423) 794-5590

Other practice location 2

4221 Fort Henry Dr Ste 100
Kingsport, TN 37663-2227
Phone (423) 239-1550

Other practice location 3

135 Commonwealth Dr
Suite 120
Greenville, SC 29615-4831
Phone (864) 483-9026

Other practice location 4

3 Professional Park Dr Ste 21
Johnson City, TN 37604-6529
Phone (423) 434-6300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151202001472 SC Practitioner - Nurse Practitioner 9739489428 Reassigns benefits to 1 organization
I20220927002562 VA Practitioner - Nurse Practitioner 9739489428

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Francis Physician Services IncGroup PAC ID 6608826821, 106 clinicians

Practice addresses (Care Compare)

10701 Anderson Rd
Easley, SC 29642-9309
Phone (864) 295-2500

1200 Brookfield Blvd
Suite 400B
Greenville, SC 29607-6583
Phone (864) 605-3721

290 Enterprise Dr
Easley, SC 29642-8280
Phone (864) 365-0290

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Francis Physician Services Inc CurrentSince Jan 28, 2024 Accepting new patients
St Francis Physician Services Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: msimon2493423@direct.bsmhealth.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 46

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 46

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755475200000",
    "number": "1902282270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 PROFESSIONAL PARK DR",
            "address_2": "STE 21",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046529",
            "telephone_number": "423-434-6300",
            "fax_number": "423-434-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 ENTERPRISE DR",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296428280",
            "telephone_number": "864-365-0290"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Med Tech Pkwy Ste 120",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376042364",
            "country_code": "US",
            "telephone_number": "423-794-5590",
            "fax_number": "423-794-5877",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4221 Fort Henry Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376632227",
            "country_code": "US",
            "telephone_number": "423-239-1550",
            "fax_number": "423-239-1544",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "135 Commonwealth Dr",
            "address_2": "Suite 120",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296154831",
            "country_code": "US",
            "telephone_number": "864-483-9026",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3 Professional Park Dr Ste 21",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046529",
            "country_code": "US",
            "telephone_number": "423-434-6300",
            "fax_number": "423-434-6312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMON",
        "first_name": "MARY",
        "middle_name": "TABATHA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-10",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "24643",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "19600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Easley, SC

Sources for this page

Verify at the official NPI Registry.