Provider Demographics
NPI:1679025787
Name:PIPKIN, JEFFREY (FNP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:PIPKIN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUNTAIN
Mailing Address - State:MS
Mailing Address - Zip Code:38610-9345
Mailing Address - Country:US
Mailing Address - Phone:662-587-1950
Mailing Address - Fax:
Practice Address - Street 1:206 OXFORD RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3115
Practice Address - Country:US
Practice Address - Phone:662-534-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily