Provider Demographics
NPI:1720690845
Name:BISHOP, TIMMI UNGER (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:TIMMI
Middle Name:UNGER
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 BREAM RD
Mailing Address - Street 2:
Mailing Address - City:MANTACHIE
Mailing Address - State:MS
Mailing Address - Zip Code:38855-8571
Mailing Address - Country:US
Mailing Address - Phone:662-871-9580
Mailing Address - Fax:
Practice Address - Street 1:188 BREAM RD
Practice Address - Street 2:
Practice Address - City:MANTACHIE
Practice Address - State:MS
Practice Address - Zip Code:38855-8571
Practice Address - Country:US
Practice Address - Phone:662-871-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-2025133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered