Healthcare Provider Details

I. General information

NPI: 1114584174
Provider Name (Legal Business Name): HAILEY E RIPPLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 BULLY BLVD
MISSISSIPPI STATE MS
39762
US

IV. Provider business mailing address

PO BOX 9855
MISSISSIPPI STATE MS
39762
US

V. Phone/Fax

Practice location:
  • Phone: 662-325-0152
  • Fax:
Mailing address:
  • Phone: 662-325-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number651230
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: