Provider Demographics
NPI:1871629279
Name:JENNINGS, KIP PHILLIPS (MPA-C)
Entity Type:Individual
Prefix:
First Name:KIP
Middle Name:PHILLIPS
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9312 HOLLY STAR
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4268
Mailing Address - Country:US
Mailing Address - Phone:210-722-7837
Mailing Address - Fax:
Practice Address - Street 1:800 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1625
Practice Address - Country:US
Practice Address - Phone:210-226-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10699363A00000X
TN1481363A00000X
NC0010-03163363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant