Provider Demographics
NPI:1275311763
Name:FORD, KIPPLIN LASHAWN
Entity Type:Individual
Prefix:
First Name:KIPPLIN
Middle Name:LASHAWN
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12250 ATLANTIC BLVD APT 1307
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5808
Mailing Address - Country:US
Mailing Address - Phone:904-424-3795
Mailing Address - Fax:
Practice Address - Street 1:8384 BAYMEADOWS RD STE 13
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7437
Practice Address - Country:US
Practice Address - Phone:904-424-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management