Provider Demographics
NPI:1487359394
Name:TRIPP, KNICHOLE LEANNE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:KNICHOLE
Middle Name:LEANNE
Last Name:TRIPP
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:KNICHOLE
Other - Middle Name:LEANNE
Other - Last Name:TRIPP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:715 WEBB TOWN RD
Mailing Address - Street 2:
Mailing Address - City:TUNNEL HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62972-3016
Mailing Address - Country:US
Mailing Address - Phone:618-771-6178
Mailing Address - Fax:
Practice Address - Street 1:211 N BROADWAY
Practice Address - Street 2:
Practice Address - City:GOREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62939-2323
Practice Address - Country:US
Practice Address - Phone:618-995-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2023004504208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice