Provider Demographics
NPI:1710502620
Name:LATTIMORE, KIPPI DENISE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIPPI
Middle Name:DENISE
Last Name:LATTIMORE
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 1:421 TIMBER RIDGE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-1433
Mailing Address - Country:US
Mailing Address - Phone:940-452-7590
Mailing Address - Fax:
Practice Address - Street 1:820 MONTGOMERY RD STE 202
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4200
Practice Address - Country:US
Practice Address - Phone:940-549-7741
Practice Address - Fax:940-549-6265
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily