Individual
KIPPEN MARSHALL JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP C
Contact information
Practice address
MILE 187 GLENN HWY, GLENNALLEN, AK 99588-0589
(907) 822-3203
(907) 822-5805
Mailing address
PO BOX 5, GLENNALLEN, AK 99588-0589
(907) 822-3203
(907) 822-5805
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
960
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497802920
NPI NUMBER
AK
01
—
K161914
MEDICARE PTAN
AK
05
—
RH047FQ
—
AK
Enumeration date
01/05/2007
Last updated
11/11/2008
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