Healthcare Provider Details

I. General information

NPI: 1518975945
Provider Name (Legal Business Name): AUNDREA JILL TIPTON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PATTONSVILLE ROAD
JACKSON OH
45640
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 740-395-8805
  • Fax: 740-395-8855
Mailing address:
  • Phone: 740-446-5371
  • Fax: 740-446-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number57516
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number299137
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: