Provider Demographics
NPI:1396704748
Name:KIPP, SHELI ROBIN (NP)
Entity type:Individual
Prefix:MRS
First Name:SHELI
Middle Name:ROBIN
Last Name:KIPP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SHELI
Other - Middle Name:
Other - Last Name:SUITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 E MARSHALL AVE
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5573
Mailing Address - Country:US
Mailing Address - Phone:903-315-2700
Mailing Address - Fax:903-236-2575
Practice Address - Street 1:705 E MARSHALL AVE
Practice Address - Street 2:SUITE 3000
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5573
Practice Address - Country:US
Practice Address - Phone:903-315-2700
Practice Address - Fax:903-236-2575
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX537073364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health