Doctor Name: | KIPPEN MARSHALL JACOBSON |
NPI Number: | 1497802920 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP C |
License Number: | 960 |
Business Practice Address: | Mile 187 Glenn Hwy Glennallen, AK - 995880589 |
Business Phone Number: | 9078223203 |
Business Fax Number: | 9078225805 |
Mailing Address: | Po Box 5, GLENNALLEN |
State: | AK |
Postal Code: | 995880589 |
Phone Number: | 9078223203 |
Fax Number: | 9078225805 |
NPI Enumeration Date: | 01/05/2007 |
NPI Last Update Date: | 11/11/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 960 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |