Provider Demographics
NPI:1720368574
Name:PIPKIN, JACQUELINE KIT (BS)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:KIT
Last Name:PIPKIN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 DORTHY ORTON DR
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-1067
Mailing Address - Country:US
Mailing Address - Phone:606-584-3295
Mailing Address - Fax:
Practice Address - Street 1:305 DORTHY ORTON DR
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-1067
Practice Address - Country:US
Practice Address - Phone:606-584-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health