Provider Demographics
NPI:1992312433
Name:CLIPPARD, JEAN L CAROLINE
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:L CAROLINE
Last Name:CLIPPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7149 WESSYNTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7548
Mailing Address - Country:US
Mailing Address - Phone:828-302-4934
Mailing Address - Fax:
Practice Address - Street 1:7149 WESSYNTON DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-7548
Practice Address - Country:US
Practice Address - Phone:828-302-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC255279363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily