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NPI Code Detail

MEDICARE: BEVERLY KIPP LPN

MEDICARE: BEVERLY KIPP LPN
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
1164W00000XLicensed Practical Nurse141550NY

General Provider Information

NPI Number : 1770243362
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEVERLY KIPP LPN
Provider Business Mailing Address
First Line : 29 N HAMILTON ST
Second Line :
City : POUGHKEEPSIE
State : NY
Zip : 12601-2541
Country : US
Telephone Number : 845-486-2703
Fax Number :
Provider Business Practice Location Address
First Line : 239 GOLDEN HILL LN
Second Line :
City : KINGSTON
State : NY
Zip : 12401-6452
Country : US
Telephone Number : 845-486-2703
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2021
Last Update Date : 12/22/2021

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Directions to “ BEVERLY KIPP LPN” Practice Location

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