Basic Information
| Provider Information | |||||||||
| NPI: | 1538367610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIPMAN | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | TUCKER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1612 FORREST AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381124925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014815787 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4095 AMERICAN WAY | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381188339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012719500 | ||||||||
| FaxNumber: | 9012719501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 46086 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1518519 | 05 | TN | MEDICAID |