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: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E MAIN ST STE D
TUPELO MS
38804-4017
US

IV. Provider business mailing address

210 E MAIN ST STE 2B
TUPELO MS
38804-4017
US

V. Phone/Fax

Practice location:
  • Phone: 662-205-6905
  • Fax: 662-269-6722
Mailing address:
  • Phone: 662-844-3728
  • Fax: 662-844-3739

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: