Provider Demographics
NPI:1326715269
Name:KIPPS, SAMANTHA MAY (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MAY
Last Name:KIPPS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SPRINGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-4548
Mailing Address - Country:US
Mailing Address - Phone:918-559-9318
Mailing Address - Fax:
Practice Address - Street 1:9175 S YALE AVE STE 220
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4043
Practice Address - Country:US
Practice Address - Phone:918-884-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK204256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily