Healthcare Provider Details

I. General information

NPI: 1205917168
Provider Name (Legal Business Name): KAREN DIANE TIPTON PMHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 MARKET POINT DR #406
GREENVILLE SC
29607-4135
US

IV. Provider business mailing address

97 MARKET POINT DR #406
GREENVILLE SC
29607-4135
US

V. Phone/Fax

Practice location:
  • Phone: 865-660-3817
  • Fax:
Mailing address:
  • Phone: 865-660-3817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number110926
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number18331
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: