Healthcare Provider Details

I. General information

NPI: 1033120571
Provider Name (Legal Business Name): A. KAY NIPPES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WAHC, CMR 467, BOX 5891 WAHC
APO AE
09096
DE

IV. Provider business mailing address

WAHC, CMR 467 P O BOX 5891
APO AE
09096
DE

V. Phone/Fax

Practice location:
  • Phone: 611-705-6480
  • Fax: 611-705-6148
Mailing address:
  • Phone: 611-705-6480
  • Fax: 611-705-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN046923
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: