Provider Demographics
NPI:1326204355
Name:FIPPS, BRIAN KIRK (PAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KIRK
Last Name:FIPPS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:PADEN
Mailing Address - State:OK
Mailing Address - Zip Code:74860-0052
Mailing Address - Country:US
Mailing Address - Phone:405-815-7461
Mailing Address - Fax:
Practice Address - Street 1:909 SOUTH OAK STREET
Practice Address - Street 2:
Practice Address - City:PADEN
Practice Address - State:OK
Practice Address - Zip Code:74860
Practice Address - Country:US
Practice Address - Phone:405-815-7461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant