Provider Demographics
NPI:1518975945
Name:TIPTON, AUNDREA JILL (CNP)
Entity Type:Individual
Prefix:
First Name:AUNDREA
Middle Name:JILL
Last Name:TIPTON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5371
Mailing Address - Fax:740-446-5711
Practice Address - Street 1:280 PATTONSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640
Practice Address - Country:US
Practice Address - Phone:740-395-8805
Practice Address - Fax:740-395-8855
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV57516363L00000X
OH299137363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2503606OtherMOLINA MEDICAID
OH2503606Medicaid
OH310917085080OtherOH MEDICAID CARESOURCE
001714158OtherMOUNTAIN STATE BCBS
WV7103239000Medicaid
P00122714OtherRR MEDICARE
OH000000204789OtherUNISON MEDICAID
000000342883OtherANTHEM BCBS
OH2503606Medicaid
000000342883OtherANTHEM BCBS