Provider Demographics
NPI:1760721039
Name:BISHOP, JOSHUA TOLLISON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:TOLLISON
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 MAIN AVE
Mailing Address - Street 2:PO BOX 1650
Mailing Address - City:PINEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24874-6000
Mailing Address - Country:US
Mailing Address - Phone:304-732-6735
Mailing Address - Fax:
Practice Address - Street 1:205 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:MULLENS
Practice Address - State:WV
Practice Address - Zip Code:25882
Practice Address - Country:US
Practice Address - Phone:304-294-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV685363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical