Provider Demographics
NPI:1245413723
Name:BISHOP, KELLIE C (MD)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:C
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5400
Mailing Address - Country:US
Mailing Address - Phone:843-524-8899
Mailing Address - Fax:843-524-8179
Practice Address - Street 1:151 DILLON RD
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-3705
Practice Address - Country:US
Practice Address - Phone:843-681-4865
Practice Address - Fax:843-689-6267
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC172562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG01476Medicare UPIN