Provider Demographics
NPI:1588901235
Name:TRIPP, KARLA SUE (RN, MSN, LMT, LDHS)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:SUE
Last Name:TRIPP
Suffix:
Gender:F
Credentials:RN, MSN, LMT, LDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49254-1416
Mailing Address - Country:US
Mailing Address - Phone:906-630-1050
Mailing Address - Fax:
Practice Address - Street 1:2151 FERGUSON RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5563
Practice Address - Country:US
Practice Address - Phone:517-474-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273211163WA2000X, 163W00000X, 163WC0400X, 163WC1500X, 163WC1600X, 163WH0200X, 163WN1003X, 163WH1000X, 163WR0400X, 163WP0000X, 163WM1400X
MI7501000642225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588901235Medicare NSC