Provider Demographics
NPI:1609981810
Name:LIPE, SHELBY (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:
Last Name:LIPE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TCHULA ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-3111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 TCHULA ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3111
Practice Address - Country:US
Practice Address - Phone:662-834-1855
Practice Address - Fax:662-834-4953
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR620688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7989254Medicaid
MSP00393344OtherMEDICARE RAILROAD
MS500002193Medicare PIN