Provider Demographics
NPI:1912792664
Name:TIPTON, ERIC DAVID (PSS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DAVID
Last Name:TIPTON
Suffix:
Gender:
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 MILLARD HWY
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-8106
Mailing Address - Country:US
Mailing Address - Phone:606-200-2254
Mailing Address - Fax:
Practice Address - Street 1:8015 MILLARD HWY
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-8106
Practice Address - Country:US
Practice Address - Phone:606-200-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist