Provider Demographics
NPI:1164801296
Name:CREECH, VICTORIA LIPPITT (PA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LIPPITT
Last Name:CREECH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ASHLEY
Other - Last Name:LIPPITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2141 PINE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1618
Mailing Address - Country:US
Mailing Address - Phone:919-631-7437
Mailing Address - Fax:
Practice Address - Street 1:145 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-4565
Practice Address - Country:US
Practice Address - Phone:919-966-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9111921363A00000X
PAMA058196363A00000X
NC001005837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant