Provider Demographics
NPI:1043842636
Name:TIPTON, ANNA INATTE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:INATTE
Last Name:TIPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-1102
Mailing Address - Country:US
Mailing Address - Phone:740-216-1173
Mailing Address - Fax:
Practice Address - Street 1:765 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1102
Practice Address - Country:US
Practice Address - Phone:740-216-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHANNA444Medicaid