Provider Demographics
NPI:1952745226
Name:TIPTON, BEVERLY FAITH-ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:FAITH-ANN
Last Name:TIPTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:43008-0227
Mailing Address - Country:US
Mailing Address - Phone:740-334-9343
Mailing Address - Fax:
Practice Address - Street 1:4711 WALNUT RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE LAKE
Practice Address - State:OH
Practice Address - Zip Code:43008-7773
Practice Address - Country:US
Practice Address - Phone:740-334-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.087233164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse