Provider Demographics
NPI:1467291880
Name:KIPPER, JAMES DANIEL (RPRS, CSAC-A)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DANIEL
Last Name:KIPPER
Suffix:
Gender:M
Credentials:RPRS, CSAC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 EWELL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2186
Mailing Address - Country:US
Mailing Address - Phone:757-254-1573
Mailing Address - Fax:
Practice Address - Street 1:325 EWELL RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2186
Practice Address - Country:US
Practice Address - Phone:757-254-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0711000673171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator