Provider Demographics
NPI:1548654585
Name:KIPP, MEGAN NICOLE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
Last Name:KIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:NICOLE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 S COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4036
Mailing Address - Country:US
Mailing Address - Phone:701-780-6000
Mailing Address - Fax:701-780-5772
Practice Address - Street 1:4440 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-7245
Practice Address - Country:US
Practice Address - Phone:701-732-7000
Practice Address - Fax:701-732-7696
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1613363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant