Basic Information
Provider Information
NPI: 1003292541
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TIPPINS
FirstName: KRISTEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CD(DONA)
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5025 CARVEL AVE
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462051220
CountryCode: US
TelephoneNumber: 3176775726
FaxNumber:  
Practice Location
Address1: 5025 CARVEL AVE
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462051220
CountryCode: US
TelephoneNumber: 3176775726
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/06/2015
LastUpdateDate: 08/06/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
374J00000X  Y Nursing Service Related ProvidersDoula 

No ID Information.


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