Provider Demographics
NPI:1457528820
Name:HIPPENSTEEL, JESSAMINE A (DO)
Entity Type:Individual
Prefix:
First Name:JESSAMINE
Middle Name:A
Last Name:HIPPENSTEEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JASSAMINE
Other - Middle Name:A
Other - Last Name:CUTSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 MERCER AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-2303
Mailing Address - Country:US
Mailing Address - Phone:260-724-2145
Mailing Address - Fax:260-728-3853
Practice Address - Street 1:815 HIGH ST
Practice Address - Street 2:SUITE C
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-2351
Practice Address - Country:US
Practice Address - Phone:260-728-3843
Practice Address - Fax:260-728-3832
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003543A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400047839Medicare PIN
IN048580P8Medicare PIN