Provider Demographics
NPI:1629453238
Name:BISHOP, TIANA MARIE STEBENS (PA)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:MARIE STEBENS
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:506 E THORPE ST
Mailing Address - Street 2:
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-9625
Mailing Address - Country:US
Mailing Address - Phone:620-355-7550
Mailing Address - Fax:620-355-7500
Practice Address - Street 1:506 E THORPE ST
Practice Address - Street 2:
Practice Address - City:LAKIN
Practice Address - State:KS
Practice Address - Zip Code:67860-9625
Practice Address - Country:US
Practice Address - Phone:620-355-7550
Practice Address - Fax:620-355-7500
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS22-03497363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant