Active NPI
Mary Jo Kippa, PA
- Physician Assistant
- McKinney, TX
National Provider Identifier
1396740437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA02397
- Practice address
- 4201 Medical Center Dr
Ste 180
McKinney, TX 75069-1766 - Phone
- (972) 548-9690
- Fax
- (214) 905-7550
- NPI assigned
- Jun 16, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA02397 | TX | Primary |
Addresses
Primary practice location
4201 Medical Center Dr
Ste 180
McKinney, TX 75069-1766
Mailing address
4201 Medical Center Dr
Ste 180
McKinney, TX 75069-1766
Phone (214) 424-3615
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA02397 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343347200000",
"number": "1396740437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 MEDICAL CENTER DR",
"address_2": "STE 180",
"city": "MCKINNEY",
"state": "TX",
"postal_code": "750691766",
"telephone_number": "214-424-3615",
"fax_number": "214-905-7550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 MEDICAL CENTER DR",
"address_2": "STE 180",
"city": "MCKINNEY",
"state": "TX",
"postal_code": "750691766",
"telephone_number": "972-548-9690",
"fax_number": "214-905-7550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIPPA",
"first_name": "MARY",
"middle_name": "JO",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-16",
"last_updated": "2012-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA02397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McKinney, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.