Provider Demographics
NPI:1346367711
Name:TRIPPET, SUSAN DANIELLE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DANIELLE
Last Name:TRIPPET
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 116
Mailing Address - Street 2:
Mailing Address - City:FORGAN
Mailing Address - State:OK
Mailing Address - Zip Code:73938-9776
Mailing Address - Country:US
Mailing Address - Phone:580-625-3477
Mailing Address - Fax:580-625-3562
Practice Address - Street 1:718 AVENUE A
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OK
Practice Address - Zip Code:73932-3101
Practice Address - Country:US
Practice Address - Phone:580-625-3477
Practice Address - Fax:580-625-3562
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKROO47882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily