Provider Demographics
NPI:1104249945
Name:PHIPPS, YVETTE N (CPED)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:N
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1071
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76068-1071
Mailing Address - Country:US
Mailing Address - Phone:940-222-0234
Mailing Address - Fax:940-468-2175
Practice Address - Street 1:1301 SE 1ST ST
Practice Address - Street 2:SUITE C
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-5507
Practice Address - Country:US
Practice Address - Phone:940-222-0234
Practice Address - Fax:940-468-2175
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCPED3729174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist