Provider Demographics
NPI:1952474926
Name:PIPKIN, NANCY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:PIPKIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:ELIZABETH
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1455 E BERT KOUNS LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5634
Mailing Address - Country:US
Mailing Address - Phone:318-798-4484
Mailing Address - Fax:318-798-4412
Practice Address - Street 1:1455 E BERT KOUNS LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5634
Practice Address - Country:US
Practice Address - Phone:318-798-4484
Practice Address - Fax:318-798-4412
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200089363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2347691Medicaid
LA5B060P863Medicare PIN
LA2347691Medicaid
LAF29735Medicare UPIN
LA312382YJSOMedicare PIN