Healthcare Provider Details
I. General information
NPI: 1588901235
Provider Name (Legal Business Name): KARLA SUE TRIPP RN, MSN, LMT, LDHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 01/14/2013
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2151 FERGUSON RD STE 101
JACKSON MI
49203-5563
US
IV. Provider business mailing address
135 EDGEWATER DR
MICHIGAN CENTER MI
49254-1416
US
V. Phone/Fax
- Phone: 517-474-0993
- Fax:
- Phone: 906-630-1050
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA2000X |
| Taxonomy | Administrator Registered Nurse |
| License Number | 4704273211 |
| License Number State | MI |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 4704273211 |
| License Number State | MI |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | 4704273211 |
| License Number State | MI |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | 4704273211 |
| License Number State | MI |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1600X |
| Taxonomy | Continuing Education/Staff Development Registered Nurse |
| License Number | 4704273211 |
| License Number State | MI |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | 4704273211 |
| License Number State | MI |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WN1003X |
| Taxonomy | Nutrition Support Registered Nurse |
| License Number | 4704273211 |
| License Number State | MI |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH1000X |
| Taxonomy | Hospice Registered Nurse |
| License Number | 4704273211 |
| License Number State | MI |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WR0400X |
| Taxonomy | Rehabilitation Registered Nurse |
| License Number | 4704273211 |
| License Number State | MI |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0000X |
| Taxonomy | Pain Management Registered Nurse |
| License Number | 4704273211 |
| License Number State | MI |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225700000X |
| Taxonomy | Massage Therapist |
| License Number | 7501000642 |
| License Number State | MI |
| # 12 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WM1400X |
| Taxonomy | Nurse Massage Therapist (NMT) |
| License Number | 4704273211 |
| License Number State | MI |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
