Healthcare Provider Details

I. General information

NPI: 1275789935
Provider Name (Legal Business Name): TIPPINI K CONLEY CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14101 HICKORY STREET
OAKLAND MS
38948-0000
US

IV. Provider business mailing address

14101 HICKORY STREET
OAKLAND MS
38948-0000
US

V. Phone/Fax

Practice location:
  • Phone: 662-623-7319
  • Fax: 662-473-4991
Mailing address:
  • Phone: 662-623-7319
  • Fax: 662-473-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR866055
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: