Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Timothy Robert Simic, NURSEPRACTITIONER

Individual provider Emergency Registered Nurse · NPI 1053904896

Timothy Robert Simic, NURSEPRACTITIONER is a Nurse Practitioner in Louisville, Kentucky. Qualified in 2004, 22 years ago. Practices with Cleanslate Medical Group of Kentucky PLLC, an 18-clinician group. Licensed in Kentucky.

Years since qualifying
22
Licensed in
KY
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

1357 Bardstown Rd
Louisville, KY 40204-1353
Phone: (502) 897-6443
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 3015217 (KY)
Emergency Registered Nurse Taxonomy 163WE0003X · Licence 1102450 (KY)

Record details

NPI number1053904896
Entity typeIndividual (Type 1)
GenderMale
Credentials NURSEPRACTITIONER
Sole proprietorYes
NPI enumeratedFebruary 12, 2021
Last updated in NPPESMarch 17, 2022
Certification dateMarch 17, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Cleanslate Medical Group Of Kentucky Pllc — 18 clinicians
Accepts Medicare assignment Not indicated

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