Provider Demographics
NPI:1598769069
Name:TIPPETT, ALETHA WISSLER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALETHA
Middle Name:WISSLER
Last Name:TIPPETT
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 1:10274 ALLIANCE RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4710
Mailing Address - Country:US
Mailing Address - Phone:513-891-3093
Mailing Address - Fax:513-891-9947
Practice Address - Street 1:10274 ALLIANCE RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-4710
Practice Address - Country:US
Practice Address - Phone:513-891-3093
Practice Address - Fax:513-891-9947
Is Sole Proprietor?:No
Enumeration Date:2005-06-11
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39281207Q00000X
OH35074933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2123508Medicaid
OH2123508Medicaid
OHG97720Medicare ID - Type Unspecified
OH2123508Medicaid