Provider Demographics
NPI:1538759378
Name:TIPPY, JESSICA NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:TIPPY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7148 SYCAMORE RUN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9438
Mailing Address - Country:US
Mailing Address - Phone:260-224-7953
Mailing Address - Fax:
Practice Address - Street 1:5559 INWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-9755
Practice Address - Country:US
Practice Address - Phone:812-342-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010776A363LF0000X
IN28232363A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71010776AOtherAPRN PRESCRIPTIVE AUTHORITY