Basic Information
| Provider Information | |||||||||
| NPI: | 1053568881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIPLING | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 SIERRA ROSE DR | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895112359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756895410 | ||||||||
| FaxNumber: | 7756895431 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 SIERRA ROSE DR | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895112359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756895410 | ||||||||
| FaxNumber: | 7756895431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2008 | ||||||||
| LastUpdateDate: | 01/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN001539 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 88-264296 | 01 | NV | TAX ID NUMBER | OTHER |