Provider Demographics
NPI:1508152992
Name:SHIPP, AMANDA KAY (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:SHIPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 KIDWELL DR
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-1784
Mailing Address - Country:US
Mailing Address - Phone:573-378-4666
Mailing Address - Fax:573-378-5099
Practice Address - Street 1:901 KIDWELL DR
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1784
Practice Address - Country:US
Practice Address - Phone:573-378-4666
Practice Address - Fax:573-378-5099
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011017330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine