Provider Demographics
NPI:1669428116
Name:CLIPPARD, DORIS A (APN)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:A
Last Name:CLIPPARD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8061 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-4705
Mailing Address - Country:US
Mailing Address - Phone:915-859-7545
Mailing Address - Fax:915-859-9862
Practice Address - Street 1:8061 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-4705
Practice Address - Country:US
Practice Address - Phone:915-859-7545
Practice Address - Fax:915-859-9862
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX854941163W00000X
TXAP125657363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130880104Medicaid
TX1831267079OtherGROUP NPI
TX1831267079OtherGROUP NPI
TX130880104Medicaid
TX1831267079OtherGROUP NPI
TX74-2505561OtherGROUP EIN