Provider Demographics
NPI:1144528258
Name:LIPPERT, KRISTINE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:LIPPERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:M
Other - Last Name:CROWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1041 N. 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101
Mailing Address - Country:US
Mailing Address - Phone:406-237-5577
Mailing Address - Fax:406-237-5575
Practice Address - Street 1:1041 N. 29TH STREET
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-237-5577
Practice Address - Fax:406-237-5575
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant