Provider Demographics
NPI:1275789935
Name:CONLEY, TIPPINI K (CFNP)
Entity Type:Individual
Prefix:
First Name:TIPPINI
Middle Name:K
Last Name:CONLEY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 HICKORY STREET
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38948-0000
Mailing Address - Country:US
Mailing Address - Phone:662-623-7319
Mailing Address - Fax:662-473-4991
Practice Address - Street 1:14101 HICKORY STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MS
Practice Address - Zip Code:38948-0000
Practice Address - Country:US
Practice Address - Phone:662-623-7319
Practice Address - Fax:662-473-4991
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512I500752OtherMEDICARE PTAN
MS01802340Medicaid