# TIPPIN FAMILY MEDICINE CLINIC, P. A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295748960
- **Authorized official:** MICHELLE JEAN BANNING-TIPPIN M.D. (OFFICE MANAGER/PHYSCIAN)
- **Authorized official phone:** (479) 495-7300

## Contact information

- **Practice address:** 804 DANARK CIRCLE, DANVILLE, AR 72833-0220
- **Practice address phone:** (479) 495-7300
- **Practice address fax:** (479) 495-7981
- **Mailing address:** 804 DANARK CIRCLE, P O BOX 220, DANVILLE, AR 72833-0220
- **Mailing address phone:** (479) 495-7300
- **Mailing address fax:** (479) 495-7981

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/14/2006
- **Last updated:** 05/15/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 121819002 | — | AR |