Provider Demographics
NPI:1417728973
Name:KIPERASH, SHANNON BRITTANY (PA-S)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:BRITTANY
Last Name:KIPERASH
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1240
Mailing Address - Country:US
Mailing Address - Phone:509-714-5212
Mailing Address - Fax:
Practice Address - Street 1:162 TEXAS ST
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1240
Practice Address - Country:US
Practice Address - Phone:509-714-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program