Healthcare Provider Details

I. General information

NPI: 1851114631
Provider Name (Legal Business Name): LUCAS STIPPLER FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 SAINT MARYS DR
EVANSVILLE IN
47714-0508
US

IV. Provider business mailing address

711 SAINT MARYS DR
EVANSVILLE IN
47714-0508
US

V. Phone/Fax

Practice location:
  • Phone: 812-476-4362
  • Fax: 812-469-3700
Mailing address:
  • Phone: 812-476-4362
  • Fax: 812-469-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016232A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: