Provider Demographics
NPI:1770521320
Name:PHIPPS, HEATHER (DO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5665
Mailing Address - Country:US
Mailing Address - Phone:509-586-2828
Mailing Address - Fax:509-586-2525
Practice Address - Street 1:711 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5665
Practice Address - Country:US
Practice Address - Phone:509-586-2828
Practice Address - Fax:509-586-2525
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001879207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH88478Medicare UPIN
WAAB38359Medicare PIN