Individual
AUNDREA JILL TIPTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
280 PATTONSVILLE ROAD, JACKSON, OH 45640
(740) 395-8805
(740) 395-8855
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5371
(740) 446-5711
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
299137
OH
363L00000X
Nurse Practitioner
57516
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000204789
UNISON MEDICAID
OH
01
—
000000342883
ANTHEM BCBS
—
01
—
001714158
MOUNTAIN STATE BCBS
—
01
—
2503606
MOLINA MEDICAID
OH
05
—
2503606
—
OH
01
—
310917085080
OH MEDICAID CARESOURCE
OH
05
—
7103239000
—
WV
01
—
P00122714
RR MEDICARE
—
Enumeration date
08/03/2006
Last updated
12/29/2020
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