Active NPI
Lisa Diane Kippenberger, PA-C
- Physician Assistant
- Oklahoma City, OK
National Provider Identifier
1881693414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA977
- Practice address
- 9600 Broadway Ext
Oklahoma City, OK 73114-7408 - Phone
- (405) 486-2140
- Fax
- (405) 486-2574
- NPI assigned
- Jul 15, 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 | PA977 | OK | Primary |
Addresses
Primary practice location
9600 Broadway Ext
Oklahoma City, OK 73114-7408
Mailing address
9600 Broadway Ext
Oklahoma City, OK 73114-7408
Phone (405) 486-2140
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100096810A | Medicaid | OK | |
| 970015207 | Other | OK | RAILROAD MEDICARE |
Other names 1
- Lisa Diane Hightower
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 |
|---|---|---|---|
| 977 | OK | MD | Marriage & Family Therapist |
| PA977 | OK | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Medical Center | Past | Accepting new patients | |
| Jackson County Memorial Hospital Authority | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Altus, OK
- NPI 1093763781
-
- General Acute Care Hospital
- Edmond, OK
- NPI 1356574560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380240000000",
"number": "1881693414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9600 BROADWAY EXT",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731147408",
"telephone_number": "405-486-2140",
"fax_number": "405-486-2574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9600 BROADWAY EXT",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731147408",
"telephone_number": "405-486-2140",
"fax_number": "405-486-2574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIPPENBERGER",
"first_name": "LISA",
"middle_name": "DIANE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-15",
"last_updated": "2013-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "PA977",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100096810A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "970015207",
"state": "OK"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "HIGHTOWER",
"middle_name": "DIANE",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.