MEDICARE: MICHELLE L. PIXLEY TIPPITT CPNP

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	208000000X	Pediatrics Physician	R656577	MS
2	363L00000X	Nurse Practitioner	ATP000518	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972706265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE L. PIXLEY TIPPITT CPNP

Provider Business Mailing Address
First Line	:	2075 HOPSON PIXLEY RD
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-9037
Country	:	US
Telephone Number	:	662-645-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 POPLAR ST
Second Line	:
City	:	HELENA
State	:	AR
Zip	:	72342-3140
Country	:	US
Telephone Number	:	870-338-8163
Fax Number	:

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	03/07/2023

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