Provider Demographics
NPI:1013193705
Name:FLIPPIN, KELLIE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ELIZABETH
Last Name:FLIPPIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:BRENNAN
Other - Last Name:RIZZIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1005 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2834
Mailing Address - Country:US
Mailing Address - Phone:217-223-8400
Mailing Address - Fax:
Practice Address - Street 1:1005 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2834
Practice Address - Country:US
Practice Address - Phone:217-223-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55731207RH0003X
NC98-01039207RH0003X
WYTL3420207RH0003X
MO2021044603207RH0003X
IL036156080207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013193705Medicaid
NC206287OtherMEDCOST
NC5908517Medicaid
WYPENDINGMedicaid
WYW27823Medicare PIN
VA1013193705Medicaid