Provider Demographics
NPI:1750416905
Name:LIPPINCOTT, LISA THERESA (NP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:THERESA
Last Name:LIPPINCOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E MAIN ST
Mailing Address - Street 2:STE 2B
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4017
Mailing Address - Country:US
Mailing Address - Phone:662-844-3728
Mailing Address - Fax:662-844-3739
Practice Address - Street 1:210 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4017
Practice Address - Country:US
Practice Address - Phone:662-205-6905
Practice Address - Fax:662-269-6722
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN18181363LP0808X
MSR679054363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02974702Medicaid
MS463942YJ5DMedicare PIN