MEDICARE: MRS. SHELBY LIPE NP

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	363L00000X	Nurse Practitioner	R620688	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00393344	OTHER	MS	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609981810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELBY LIPE NP

Provider Business Mailing Address
First Line	:	110 TCHULA ST
Second Line	:
City	:	LEXINGTON
State	:	MS
Zip	:	39095-3111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 TCHULA ST
Second Line	:
City	:	LEXINGTON
State	:	MS
Zip	:	39095-3111
Country	:	US
Telephone Number	:	662-834-1855
Fax Number	:	662-834-4953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/16/2011

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