Provider Demographics
NPI:1013265487
Name:BISHOP, HEIDI FORTE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:HEIDI
Middle Name:FORTE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:HEIDI
Other - Middle Name:JO
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1335
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28201-1335
Mailing Address - Country:US
Mailing Address - Phone:252-451-2700
Mailing Address - Fax:252-451-2702
Practice Address - Street 1:1041 NOELL LN
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2058
Practice Address - Country:US
Practice Address - Phone:252-451-2700
Practice Address - Fax:252-451-2702
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001003693363A00000X
NC0010-03693363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102643Medicaid
NCNC8269AMedicare PIN