Healthcare Provider Details

I. General information

NPI: 1750416905
Provider Name (Legal Business Name): LISA THERESA LIPPINCOTT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 ENTERPRISE DR
OXFORD MS
38655-2761
US

IV. Provider business mailing address

202 ENTERPRISE DR
OXFORD MS
38655-2761
US

V. Phone/Fax

Practice location:
  • Phone: 662-371-1711
  • Fax: 662-371-1342
Mailing address:
  • Phone: 662-371-1711
  • Fax: 662-371-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN18181
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR679054
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: