Provider Demographics
NPI:1972284685
Name:BISHOP, NICOLE EVELYN
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:EVELYN
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 DELMAR PL
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014-1421
Mailing Address - Country:US
Mailing Address - Phone:859-760-8881
Mailing Address - Fax:
Practice Address - Street 1:416 DELMAR PL
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41014-1421
Practice Address - Country:US
Practice Address - Phone:859-760-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYG01-509-809175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist