Provider Demographics
NPI:1275030884
Name:KIPP, ERIN ELLYCE (DO)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ELLYCE
Last Name:KIPP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 LAKE BROOK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3761
Mailing Address - Country:US
Mailing Address - Phone:865-374-0600
Mailing Address - Fax:
Practice Address - Street 1:3001 LAKE BROOK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3761
Practice Address - Country:US
Practice Address - Phone:865-374-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4947207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ077990Medicaid