Basic Information
| Provider Information | |||||||||
| NPI: | 1588083133 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIPPITT | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 506 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383440506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314255752 | ||||||||
| FaxNumber: | 7314255783 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 W PARIS ST | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383443608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315353600 | ||||||||
| FaxNumber: | 7315353603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2014 | ||||||||
| LastUpdateDate: | 04/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 18636 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | Q014557 | 05 | TN | MEDICAID |