Provider Demographics
NPI:1972706265
Name:TIPPITT, MICHELLE L PIXLEY (CPNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L PIXLEY
Last Name:TIPPITT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 HOPSON PIXLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-9037
Mailing Address - Country:US
Mailing Address - Phone:662-645-0440
Mailing Address - Fax:
Practice Address - Street 1:626 POPLAR ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-3140
Practice Address - Country:US
Practice Address - Phone:870-338-8163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR656577208000000X
ARATP000518363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05872856Medicaid
MSMT2724676OtherDEA