Healthcare Provider Details

I. General information

NPI: 1588852412
Provider Name (Legal Business Name): KELLY JEAN CIPPARONE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR BLDG 3, SUITE 300
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

2200 PARK BEND DR BLDG 3, SUITE 300
AUSTIN TX
78758-5387
US

V. Phone/Fax

Practice location:
  • Phone: 512-467-2727
  • Fax: 512-873-7576
Mailing address:
  • Phone: 512-467-2727
  • Fax: 512-873-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number656529
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: