Provider Demographics
NPI:1801134911
Name:PHIPPS, VANESSA HAYNES (CPNP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:HAYNES
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:1318 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375
Mailing Address - Country:US
Mailing Address - Phone:931-598-9761
Mailing Address - Fax:931-598-5038
Practice Address - Street 1:6172 AIRWAYS BLVD STE 122
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2915
Practice Address - Country:US
Practice Address - Phone:423-622-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17071363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics