MEDICARE: MARQUEL TIPTON PA-C

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	363A00000X	Physician Assistant	PA1002	KY

General Provider Information

NPI Number	:	1558552067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUEL TIPTON PA-C

Provider Business Mailing Address
First Line	:	2509 ENID ST
Second Line	:
City	:	CRESCENT SPRINGS
State	:	KY
Zip	:	41017-1508
Country	:	US
Telephone Number	:	859-322-9984
Fax Number	:

Provider Business Practice Location Address
First Line	:	2091 N BEND RD
Second Line	:	SUITE 100
City	:	HEBRON
State	:	KY
Zip	:	41048-9691
Country	:	US
Telephone Number	:	859-817-1370
Fax Number	:

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

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	09/07/2018

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Directions to “ MARQUEL TIPTON PA-C” Practice Location

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