Provider Demographics
NPI:1205942794
Name:KIPPELS, ANDREA J (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:J
Last Name:KIPPELS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 BURGUNDY RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3306
Mailing Address - Country:US
Mailing Address - Phone:770-270-1148
Mailing Address - Fax:
Practice Address - Street 1:1841 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4021
Practice Address - Country:US
Practice Address - Phone:404-728-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN065116 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBGSQMedicare ID - Type UnspecifiedCMS CARRIER PROVIDER #
GAP88812Medicare UPIN