Provider Demographics
NPI:1093241051
Name:HIPP, STACIE L (APRN)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:L
Last Name:HIPP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:MOUNT IDA
Mailing Address - State:AR
Mailing Address - Zip Code:71957-9516
Mailing Address - Country:US
Mailing Address - Phone:870-489-3847
Mailing Address - Fax:
Practice Address - Street 1:320 LUZERNE ST
Practice Address - Street 2:
Practice Address - City:MOUNT IDA
Practice Address - State:AR
Practice Address - Zip Code:71957-9437
Practice Address - Country:US
Practice Address - Phone:870-867-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily