Healthcare Provider Details

I. General information

NPI: 1780497909
Provider Name (Legal Business Name): KATHRYN PIPPIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 E BEOUFF ST
EUDORA AR
71640-3090
US

IV. Provider business mailing address

2998 HIGHWAY 882
LAKE PROVIDENCE LA
71254-4333
US

V. Phone/Fax

Practice location:
  • Phone: 870-355-2512
  • Fax:
Mailing address:
  • Phone: 318-816-1493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number239716
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: