Provider Demographics
NPI:1184235376
Name:KIPE, ELIZABETH MCKENZIE (PA)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MCKENZIE
Last Name:KIPE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:MCKENZIE
Other - Middle Name:
Other - Last Name:KIPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:380A 49TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2237
Mailing Address - Country:US
Mailing Address - Phone:949-350-0059
Mailing Address - Fax:
Practice Address - Street 1:100 PARK PL STE 200
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4416
Practice Address - Country:US
Practice Address - Phone:925-867-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant