Basic Information
| Provider Information | |||||||||
| NPI: | 1093241051 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIPP | ||||||||
| FirstName: | STACIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2819 HIGHWAY 27 S | ||||||||
| Address2: | |||||||||
| City: | MOUNT IDA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719579516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704893847 | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 LUZERNE ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT IDA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719579437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708672175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A005086 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.