Provider Demographics
NPI:1437258191
Name:HIPP, DEBORAH L (NP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:HIPP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 GIST LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-5438
Mailing Address - Country:US
Mailing Address - Phone:866-418-9211
Mailing Address - Fax:866-469-9514
Practice Address - Street 1:152 WACCAMAW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8901
Practice Address - Country:US
Practice Address - Phone:866-418-9211
Practice Address - Fax:866-469-9514
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF1320363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1614Medicaid
SCP14005Medicare UPIN