MEDICARE: MRS. SHELI ROBIN KIPP NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SW0102X	Women's Health Clinical Nurse Specialist	537073	TX

General Provider Information

NPI Number	:	1396704748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELI ROBIN KIPP NP

Provider Business Mailing Address
First Line	:	705 E MARSHALL AVE
Second Line	:	SUITE 3000
City	:	LONGVIEW
State	:	TX
Zip	:	75601-5573
Country	:	US
Telephone Number	:	903-315-2700
Fax Number	:	903-236-2575

Provider Business Practice Location Address
First Line	:	705 E MARSHALL AVE
Second Line	:	SUITE 3000
City	:	LONGVIEW
State	:	TX
Zip	:	75601-5573
Country	:	US
Telephone Number	:	903-315-2700
Fax Number	:	903-236-2575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	05/09/2011

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