Provider Demographics
NPI:1194110924
Name:SHIPES, BRITTANY B (APRN)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:B
Last Name:SHIPES
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 1:6210 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4413
Mailing Address - Country:US
Mailing Address - Phone:035-792-7009
Mailing Address - Fax:903-579-2799
Practice Address - Street 1:6210 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4413
Practice Address - Country:US
Practice Address - Phone:035-792-7009
Practice Address - Fax:903-579-2799
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22444363LF0000X
TXAP127832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP5720Medicaid