Provider Demographics
NPI:1396740437
Name:KIPPA, MARY JO (PA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:KIPPA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4201 MEDICAL CENTER DR
Mailing Address - Street 2:STE 180
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1766
Mailing Address - Country:US
Mailing Address - Phone:214-424-3615
Mailing Address - Fax:214-905-7550
Practice Address - Street 1:4201 MEDICAL CENTER DR
Practice Address - Street 2:STE 180
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1766
Practice Address - Country:US
Practice Address - Phone:972-548-9690
Practice Address - Fax:214-905-7550
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-07-27
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Provider Licenses
StateLicense IDTaxonomies
TXPA02397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P53655Medicare UPIN
TX8002B7Medicare PIN
TX87N250Medicare PIN