Provider Demographics
NPI:1710246962
Name:BISHOP, KATHLEEN N (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:N
Last Name:BISHOP
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WINCHESTER DR
Mailing Address - Street 2:APT 402
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6096
Mailing Address - Country:US
Mailing Address - Phone:337-967-2297
Mailing Address - Fax:
Practice Address - Street 1:100 WINCHESTER DR
Practice Address - Street 2:APT 402
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6096
Practice Address - Country:US
Practice Address - Phone:337-967-2297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1063891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered