Individual
MRS. AMANDA WHITAKER TIPTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1901 MOONEY ST, WINSTON SALEM, NC 27103-3032
(336) 716-2011
Mailing address
1370 ABINGDON WAY, WINSTON SALEM, NC 27106-4478
(661) 857-1041
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-06441
NC
363A00000X
Physician Assistant
PA22505
CA
Other
Enumeration date
09/02/2012
Last updated
10/14/2016
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