Provider Demographics
NPI:1447602701
Name:SHIPP, KRISTI
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:SHIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 LATHAM ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-2108
Mailing Address - Country:US
Mailing Address - Phone:901-359-1044
Mailing Address - Fax:901-236-7147
Practice Address - Street 1:1040 LATHAM ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-2108
Practice Address - Country:US
Practice Address - Phone:901-359-1044
Practice Address - Fax:901-236-7147
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLOOOOOOO18655374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide