Provider Demographics
NPI:1467088351
Name:BISHOP, KATELYN ANNE (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:ANNE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 TRAVIS EDWARD WAY
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3037
Mailing Address - Country:US
Mailing Address - Phone:703-919-9447
Mailing Address - Fax:
Practice Address - Street 1:4201 STRINGFELLOW RD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2600
Practice Address - Country:US
Practice Address - Phone:571-363-7835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260017082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000003812OtherBOARD OF CERTIFICATION FOR ATHLETIC TRAINER