Provider Demographics
NPI:1841337417
Name:LIPPOLD, KRISTA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:
Last Name:LIPPOLD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746063
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6063
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:3065 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4040
Practice Address - Country:US
Practice Address - Phone:251-271-7017
Practice Address - Fax:251-220-5536
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-066260363LF0000X
MSR881358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631300121Medicaid
AL631300121Medicaid
AL011855Medicare ID - Type Unspecified