| Doctor Name: | MS. KELLY COLLEEN SIPE |
| NPI Number: | 1205068665 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 146475 |
| Business Practice Address: | 126 Missouri Ave Fort Leonard Wood, MO - 654738952 |
| Business Phone Number: | 5733291932 |
| Business Fax Number: | 5733298529 |
| Mailing Address: | 126 Missouri Ave, FORT LEONARD WOOD |
| State: | MO |
| Postal Code: | 654738952 |
| Phone Number: | 5733291932 |
| Fax Number: | 5733298529 |
| NPI Enumeration Date: | 08/19/2009 |
| NPI Last Update Date: | 08/19/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 146475 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |