Provider Demographics
NPI:1235598061
Name:LIPPS, JENNIFER ANN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:LIPPS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 BUSINESS PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-6503
Mailing Address - Country:US
Mailing Address - Phone:423-339-8881
Mailing Address - Fax:423-464-6126
Practice Address - Street 1:2550 BUSINESS PARK DR NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-6503
Practice Address - Country:US
Practice Address - Phone:423-339-8881
Practice Address - Fax:423-464-6126
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN020952367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ023736Medicaid