Provider Demographics
NPI:1629578273
Name:BISHOP, ORLESHA CARROLL (FNP)
Entity Type:Individual
Prefix:MS
First Name:ORLESHA
Middle Name:CARROLL
Last Name:BISHOP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GREEN GATE XING
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-9711
Mailing Address - Country:US
Mailing Address - Phone:601-259-3016
Mailing Address - Fax:
Practice Address - Street 1:805 E RIVER PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-3486
Practice Address - Country:US
Practice Address - Phone:601-500-7660
Practice Address - Fax:769-243-7946
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902200363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS$$$$$$$$$OtherSOCIAL SECURITY