Provider Demographics
NPI:1073236832
Name:BISHOP, SKYLAR MISHAEL
Entity Type:Individual
Prefix:
First Name:SKYLAR
Middle Name:MISHAEL
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SKYLAR
Other - Middle Name:MISHAEL
Other - Last Name:RAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104252 S 4769 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-5455
Mailing Address - Country:US
Mailing Address - Phone:539-230-1010
Mailing Address - Fax:
Practice Address - Street 1:1108 N WHEELER AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2227
Practice Address - Country:US
Practice Address - Phone:918-775-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator