Provider Demographics
NPI:1801008792
Name:HIPPS, HOLLY JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:JEAN
Last Name:HIPPS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OAK HILL LANE
Mailing Address - Street 2:
Mailing Address - City:OLANTA
Mailing Address - State:PA
Mailing Address - Zip Code:16863
Mailing Address - Country:US
Mailing Address - Phone:814-236-1687
Mailing Address - Fax:
Practice Address - Street 1:1033 TURNPIKE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3061
Practice Address - Country:US
Practice Address - Phone:814-768-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051098363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical