Provider Demographics
NPI:1538257399
Name:TRIPPY, ERIN JUDITH (ARNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:JUDITH
Last Name:TRIPPY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:JUDITH
Other - Last Name:WICHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:35620 W 101ST ST S
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-6370
Mailing Address - Country:US
Mailing Address - Phone:918-729-0654
Mailing Address - Fax:
Practice Address - Street 1:900 WEST TURCK BYPASS
Practice Address - Street 2:
Practice Address - City:DRUMRIGHT
Practice Address - State:OK
Practice Address - Zip Code:74030-0090
Practice Address - Country:US
Practice Address - Phone:918-352-9001
Practice Address - Fax:918-352-9194
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0034063363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100204250AMedicaid
OK100204250AMedicaid
P11184Medicare UPIN