Provider Demographics
NPI:1902042104
Name:TIPPETS, TRACY HUGH (RPA)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:HUGH
Last Name:TIPPETS
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 OAK LN
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1635
Mailing Address - Country:US
Mailing Address - Phone:801-543-1301
Mailing Address - Fax:
Practice Address - Street 1:240 OAK LN
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1635
Practice Address - Country:US
Practice Address - Phone:801-543-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT09 UT 1-14243U00000X
UT119162-54012471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography