Provider Demographics
NPI:1205917168
Name:TIPTON, KAREN DIANE (PMHCNS)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DIANE
Last Name:TIPTON
Suffix:
Gender:F
Credentials:PMHCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 MARKET POINT DR
Mailing Address - Street 2:#406
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4135
Mailing Address - Country:US
Mailing Address - Phone:865-660-3817
Mailing Address - Fax:
Practice Address - Street 1:97 MARKET POINT DR
Practice Address - Street 2:#406
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4135
Practice Address - Country:US
Practice Address - Phone:865-660-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN110926363LP0808X
SC18331364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS87864Medicare UPIN
TN3904223Medicare ID - Type Unspecified