Provider Demographics
NPI:1083215867
Name:TIPTON, ROBERT FRANK JR (PARA PROFESSIONAL)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANK
Last Name:TIPTON
Suffix:JR
Gender:M
Credentials:PARA PROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-0148
Mailing Address - Country:US
Mailing Address - Phone:918-244-9877
Mailing Address - Fax:
Practice Address - Street 1:618 E CANADIAN AVE
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-3810
Practice Address - Country:US
Practice Address - Phone:918-256-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRC1804-18043104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness