Provider Demographics
NPI:1487200283
Name:PIPPIN, AUSTIN ROBERT (PA)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:ROBERT
Last Name:PIPPIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7593
Mailing Address - Country:US
Mailing Address - Phone:910-763-3333
Mailing Address - Fax:910-763-3336
Practice Address - Street 1:2208 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7593
Practice Address - Country:US
Practice Address - Phone:910-763-3333
Practice Address - Fax:910-763-3336
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant