Provider Demographics
NPI:1457901092
Name:BISHOP, KASSIDY B (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:KASSIDY
Middle Name:B
Last Name:BISHOP
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:419-824-1785
Mailing Address - Fax:419-824-5953
Practice Address - Street 1:5308 HARROUN RD # 285
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2193
Practice Address - Country:US
Practice Address - Phone:419-824-1785
Practice Address - Fax:419-824-5953
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025629363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner