Provider Demographics
NPI:1679016034
Name:TIPPENS, JULIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:TIPPENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S MEDICAL ARTS CT
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3364
Mailing Address - Country:US
Mailing Address - Phone:307-685-6500
Mailing Address - Fax:307-685-3081
Practice Address - Street 1:430 S MEDICAL ARTS CT
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3364
Practice Address - Country:US
Practice Address - Phone:307-685-6500
Practice Address - Fax:307-685-3081
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY40987.1701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4720OtherGROUP #