Provider Demographics
NPI:1598289662
Name:BISHOP, JENNIFER LYN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 JOCKEY HOLW
Mailing Address - Street 2:
Mailing Address - City:AUXIER
Mailing Address - State:KY
Mailing Address - Zip Code:41602-9225
Mailing Address - Country:US
Mailing Address - Phone:606-339-0645
Mailing Address - Fax:
Practice Address - Street 1:23 WILLOW DR
Practice Address - Street 2:
Practice Address - City:AUXIER
Practice Address - State:KY
Practice Address - Zip Code:41602-9259
Practice Address - Country:US
Practice Address - Phone:606-886-8997
Practice Address - Fax:606-886-1021
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty