Basic Information
| Provider Information | |||||||||
| NPI: | 1689981730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIPPERT | ||||||||
| FirstName: | JANINE | ||||||||
| MiddleName: | TERESA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 WELLINGTON WAY | ||||||||
| Address2: | SUITE 275 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405131259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592192828 | ||||||||
| FaxNumber: | 8592190524 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 PALUMBO DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592788772 | ||||||||
| FaxNumber: | 8592763565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2010 | ||||||||
| LastUpdateDate: | 09/10/2010 | ||||||||
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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 | 363LP0200X | 6590P | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1086377 | 01 | KY | RN LICENSE NUMBER | OTHER |