Provider Demographics
NPI:1881231074
Name:LIPPARD, ALICIA C (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:C
Last Name:LIPPARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11042 E BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:APISON
Mailing Address - State:TN
Mailing Address - Zip Code:37302
Mailing Address - Country:US
Mailing Address - Phone:423-595-5253
Mailing Address - Fax:
Practice Address - Street 1:2341 MCCALLIE AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3241
Practice Address - Country:US
Practice Address - Phone:423-629-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000025858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily