Provider Demographics
NPI:1851937700
Name:BISHOP, HEATHER SUSANNE
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:SUSANNE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:SUSANNE
Other - Last Name:LAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 HILLRISE DR
Mailing Address - Street 2:
Mailing Address - City:SCIENCE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:42553-8401
Mailing Address - Country:US
Mailing Address - Phone:606-875-9935
Mailing Address - Fax:
Practice Address - Street 1:607 CLIFTY ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1765
Practice Address - Country:US
Practice Address - Phone:606-485-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2044895164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse