Provider Demographics
NPI:1427149806
Name:KRIPAL, MARK ANTON (MS CCCA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTON
Last Name:KRIPAL
Suffix:
Gender:M
Credentials:MS CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 795
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-0795
Mailing Address - Country:US
Mailing Address - Phone:308-532-3330
Mailing Address - Fax:308-532-6354
Practice Address - Street 1:801 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101
Practice Address - Country:US
Practice Address - Phone:308-532-3330
Practice Address - Fax:308-532-6354
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE166231H00000X
NE639237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025-1338-00Medicaid
36804OtherB/C
NE10025-1241-00Medicaid
099558Medicare ID - Type Unspecified