Provider Demographics
NPI:1093463234
Name:JIPSON, NATHAN AUGUST
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:AUGUST
Last Name:JIPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 CARR LOOP
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-1572
Mailing Address - Country:US
Mailing Address - Phone:218-343-8284
Mailing Address - Fax:
Practice Address - Street 1:8787 CARR LOOP
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-1572
Practice Address - Country:US
Practice Address - Phone:218-343-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM77863363LP0808X
COAPN.0999071-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty