Provider Demographics
NPI:1003329111
Name:NIPPERS, KATHY W (FNP)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:W
Last Name:NIPPERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:JEAN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 TUSCARAWAS ST W STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4696
Mailing Address - Country:US
Mailing Address - Phone:330-452-8844
Mailing Address - Fax:
Practice Address - Street 1:2600 TUSCARAWAS ST W STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4696
Practice Address - Country:US
Practice Address - Phone:330-452-8844
Practice Address - Fax:434-245-3535
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22607163W00000X, 163WF0300X
VA0024187761207Q00000X, 363LF0000X
OH0030119363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WF0300XNursing Service ProvidersRegistered NurseFlight
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily