Healthcare Provider Details

I. General information

NPI: 1407769003
Provider Name (Legal Business Name): PATRICIA LYNN NIPPS AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 FRANCISCAN DR
BRYAN TX
77802-2544
US

IV. Provider business mailing address

2700 OSLER BLVD
BRYAN TX
77802-2517
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-3777
  • Fax:
Mailing address:
  • Phone: 979-776-8291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1250228
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1250228
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1250228
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: