Provider Demographics
NPI:1831438076
Name:LIPPE, RACHAEL LEIGH (PA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LEIGH
Last Name:LIPPE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:LEIGH
Other - Last Name:RODICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7800 NW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4050 W MEMORIAL RD FL 3
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8382
Practice Address - Country:US
Practice Address - Phone:405-608-3800
Practice Address - Fax:405-608-1240
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2198363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200488730AMedicaid
OK200488730AMedicaid