Healthcare Provider Details

I. General information

NPI: 1316450497
Provider Name (Legal Business Name): JENNIFER LYNN SHIPP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207A E MARSHALL AVE
LONGVIEW TX
75601-5604
US

IV. Provider business mailing address

PO BOX 746079
ATLANTA GA
30374-6079
US

V. Phone/Fax

Practice location:
  • Phone: 903-907-7003
  • Fax: 430-558-5861
Mailing address:
  • Phone: 773-352-1515
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135184
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: