Provider Demographics
NPI:1275551723
Name:LYP, ANN ELLIS (APN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ELLIS
Last Name:LYP
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 POYDRAS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2127
Mailing Address - Country:US
Mailing Address - Phone:501-280-3342
Mailing Address - Fax:501-280-3144
Practice Address - Street 1:3915 W 8TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2028
Practice Address - Country:US
Practice Address - Phone:501-280-3342
Practice Address - Fax:501-280-3144
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR31695163WC1500X
ARA001073363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health