Provider Demographics
NPI:1659868933
Name:SHIPP, ALEXA (APRN)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:SHIPP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BRANDON CIR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7503
Mailing Address - Country:US
Mailing Address - Phone:870-378-0061
Mailing Address - Fax:
Practice Address - Street 1:525 WESTERN AVE STE 202
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4980
Practice Address - Country:US
Practice Address - Phone:501-358-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-22
Last Update Date:2018-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005530363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care