Provider Demographics
NPI:1851378525
Name:LIPSON, MINDY J (RN/NP)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:J
Last Name:LIPSON
Suffix:
Gender:F
Credentials:RN/NP
Other - Prefix:MS
Other - First Name:MINDY
Other - Middle Name:NMN
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, PNP-BC
Mailing Address - Street 1:5293 S ANGELA RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2203
Mailing Address - Country:US
Mailing Address - Phone:901-761-0422
Mailing Address - Fax:
Practice Address - Street 1:5293 S ANGELA RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2203
Practice Address - Country:US
Practice Address - Phone:901-761-0422
Practice Address - Fax:901-683-8700
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN60214363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149326758Medicaid
AR99423OtherBCBS AR
SCQNP019Medicaid
TN3349720Medicaid
MO425861101Medicaid
LA1138321Medicaid
MS00126536Medicaid
KS200390060AMedicaid