Provider Demographics
NPI:1194048116
Name:TIPPETT, JERLENE BONNER
Entity type:Individual
Prefix:MRS
First Name:JERLENE
Middle Name:BONNER
Last Name:TIPPETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 BUNCH DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112
Mailing Address - Country:US
Mailing Address - Phone:817-446-3662
Mailing Address - Fax:817-446-3191
Practice Address - Street 1:1701 BUNCH DR
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112
Practice Address - Country:US
Practice Address - Phone:817-446-3662
Practice Address - Fax:817-446-3191
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide