Provider Demographics
NPI:1922406545
Name:TIPTON, KIMBERLY C (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:TIPTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 INDUSTRIAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744-6263
Mailing Address - Country:US
Mailing Address - Phone:417-876-5700
Mailing Address - Fax:
Practice Address - Street 1:1301 INDUSTRIAL PKWY E
Practice Address - Street 2:
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744-6263
Practice Address - Country:US
Practice Address - Phone:417-876-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-13
Last Update Date:2014-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116499163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult