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NPI Code Detail

MEDICARE: JACKI L KIPE CRNA

MEDICARE: JACKI L KIPE CRNA
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
1367500000XCertified Registered Nurse Anesthetist170699CO

General Provider Information

NPI Number : 1710984307
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKI L KIPE CRNA
Provider Business Mailing Address
First Line : 1218 N MAIN ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-2828
Country : US
Telephone Number : 719-543-7827
Fax Number : 719-543-7882
Provider Business Practice Location Address
First Line : 400 W 16TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-2745
Country : US
Telephone Number : 719-543-7877
Fax Number : 719-543-7882
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 11/05/2007

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Directions to “ JACKI L KIPE CRNA” Practice Location

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