=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881404275
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY ANNE XIN TRIPP APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2025
-----------------------------------------------------
Last Update Date | 04/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4000 MIAMISBURG CENTERVILLE RD STE 104
-----------------------------------------------------
City | MIAMISBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45342-3674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-384-8780
-----------------------------------------------------
Fax | 937-384-4876
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7876 TALL TREES CT
-----------------------------------------------------
City | SPRINGBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45066-7511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-254-2617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0037692
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------