Provider Demographics
NPI:1720440787
Name:LISA LIPPINCOTT APMHNP-BC PLLC
Entity type:Organization
Organization Name:LISA LIPPINCOTT APMHNP-BC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIPPINCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:APMHNP-BC
Authorized Official - Phone:662-844-3728
Mailing Address - Street 1:210 E MAIN ST
Mailing Address - Street 2:STE 2B
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4017
Mailing Address - Country:US
Mailing Address - Phone:662-844-3728
Mailing Address - Fax:662-844-3739
Practice Address - Street 1:210 E MAIN ST
Practice Address - Street 2:STE 2B
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4017
Practice Address - Country:US
Practice Address - Phone:662-844-3728
Practice Address - Fax:662-844-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR679054363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty