MEDICARE: KIPP DELTA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1396873030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIPP DELTA INC

Provider Business Mailing Address
First Line	:	215 CHERRY ST
Second Line	:
City	:	HELENA
State	:	AR
Zip	:	72342-3503
Country	:	US
Telephone Number	:	870-753-9444
Fax Number	:	870-753-9450

Provider Business Practice Location Address
First Line	:	215 CHERRY ST
Second Line	:
City	:	HELENA
State	:	AR
Zip	:	72342-3503
Country	:	US
Telephone Number	:	870-753-9444
Fax Number	:	870-753-9450

Authorized Official
Title or Position	:	SCHOOL DIRECTOR
Name	:	MR. SCOTT SHIREY
Credential	:
Telephone Number	:	870-753-9444

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	08/22/2020

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Directions to “KIPP DELTA INC ” Practice Location

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