Provider Demographics
NPI:1861031171
Name:KIPP, JENNY E (DNP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:E
Last Name:KIPP
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8681 VICKERYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FENWICK
Mailing Address - State:MI
Mailing Address - Zip Code:48834-9753
Mailing Address - Country:US
Mailing Address - Phone:989-330-4484
Mailing Address - Fax:
Practice Address - Street 1:811 E KENT RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-9791
Practice Address - Country:US
Practice Address - Phone:616-225-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG07190290363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner