Provider Demographics
NPI:1184112138
Name:BISE, KINSEY LEIGH (MD)
Entity type:Individual
Prefix:
First Name:KINSEY
Middle Name:LEIGH
Last Name:BISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E BROAD STREET
Mailing Address - Street 2:WEST HOSPITAL, 8TH FLOOR
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298
Mailing Address - Country:US
Mailing Address - Phone:804-828-4570
Mailing Address - Fax:804-828-4614
Practice Address - Street 1:1300 E. MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298
Practice Address - Country:US
Practice Address - Phone:804-828-9000
Practice Address - Fax:804-828-4614
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012675462084P0800X
390200000X
VA01160316272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program