Provider Demographics
NPI:1851794143
Name:TIPPENS, KIMBERLY (ND, MSAOM, MPH)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:TIPPENS
Suffix:
Gender:F
Credentials:ND, MSAOM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:049 SW PORTER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-4848
Mailing Address - Country:US
Mailing Address - Phone:503-552-1857
Mailing Address - Fax:503-227-3750
Practice Address - Street 1:049 SW PORTER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4848
Practice Address - Country:US
Practice Address - Phone:503-552-1857
Practice Address - Fax:503-227-3750
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00876171100000X
OR1355175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist