Healthcare Provider Details

I. General information

NPI: 1295748960
Provider Name (Legal Business Name): TIPPIN FAMILY MEDICINE CLINIC, P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 DANARK CIRCLE
DANVILLE AR
72833-0220
US

IV. Provider business mailing address

804 DANARK CIRCLE P O BOX 220
DANVILLE AR
72833-0220
US

V. Phone/Fax

Practice location:
  • Phone: 479-495-7300
  • Fax: 479-495-7981
Mailing address:
  • Phone: 479-495-7300
  • Fax: 479-495-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE JEAN BANNING-TIPPIN
Title or Position: OFFICE MANAGER/PHYSCIAN
Credential: M.D.
Phone: 479-495-7300