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NPI Code Detail

MEDICARE: CRYSTAL TIPPETT NP

MEDICARE:   CRYSTAL  TIPPETT  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
1363LF0000XFamily Nurse Practitioner24404SC

General Provider Information

NPI Number : 1720676562
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL TIPPETT NP
Provider Business Mailing Address
First Line : 5 MOORLAND WAY
Second Line :
City : SIMPSONVILLE
State : SC
Zip : 29681-7125
Country : US
Telephone Number : 864-884-9626
Fax Number :
Provider Business Practice Location Address
First Line : 440 N DUNCAN BYP
Second Line :
City : UNION
State : SC
Zip : 29379-8604
Country : US
Telephone Number : 864-424-9576
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2021
Last Update Date : 01/07/2021

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Directions to “ CRYSTAL TIPPETT NP” Practice Location

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