Provider Demographics
NPI:1558666941
Name:KNIPP, LISA ELAINE (KCSA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ELAINE
Last Name:KNIPP
Suffix:
Gender:F
Credentials:KCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 LITTLE CURRENT TRL
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8535
Mailing Address - Country:US
Mailing Address - Phone:606-528-1920
Mailing Address - Fax:
Practice Address - Street 1:72 LITTLE CURRENT TRL
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8535
Practice Address - Country:US
Practice Address - Phone:606-528-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA221363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical