Timothy Shipp, PA-C
Individual provider Active NPI Physician Assistant · Little Rock Afb, AR
NPI 1780938951 · NPPES record last updated Jul 1, 2025
Key facts
- NPI
- 1780938951
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA-500 (AR)
- Practice address
- 101 MSGT Dan Wassom Road
Little Rock Afb, AR 72099-0001 - Phone
- (501) 987-6951
- NPI assigned
- Nov 8, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 11
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130429000148 | AR | Practitioner - Physician Assistant | 2466698980 | Reassigns benefits to 6 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-500 | AR | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conway Regional Medical Center Inc | Current |
Accepting new patients | |
| St Vincent Infirmary Medical Center | Current |
Accepting new patients | |
| Forrest City Emergency Physicians, PLLC | Physician Assistant | Current |
Accepting new patients |
| St. Vincent Infirmary Medical Center | Current |
Accepting new patients | |
| Southeast Arkansas Emergency Physicians LLP | Physician Assistant | Current |
Accepting new patients |
| South Arkansas Pathology, PLLC | Current | Accepting new patients |
Locations
2302 College Ave
Conway, AR 72034
Phone (501) 329-3831
1601 New Castle Rd
Forrest City, AR 72335
Phone (870) 261-0000
2 Saint Vincent Cir
Little Rock, AR 72205
Phone (501) 552-2680
10100 Kanis Rd
Little Rock, AR 72205
Phone (501) 255-6000
1600 W 40th Ave
Pine Bluff, AR 71603
Phone (870) 541-7100
2215 Wildwood Ave
Sherwood, AR 72120
Phone (501) 522-7100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-500 | AR | Yes |
Addresses
Primary practice location
101 MSGT Dan Wassom Road
Little Rock Afb, AR 72099-0001
Mailing address
101 MSGT Dan Wassom Road
Little Rock Afb, AR 72099-0001
Phone (501) 987-6951
Other providers in Little Rock Afb, AR
- Christine Lynnette Roth
- Joshua Routt
- Jeff J. Sandoval
- Kristie R Sandusky
- Samuel Schmidt
- Susan Bratcher Smith
- Yoohyun Song
- Timothy Ryan Southerland
- Anna R. Stanton
- Sunland Optical Co., Inc.
All providers in Little Rock Afb, AR · Physician Assistant in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.