Provider Demographics
NPI:1912956202
Name:BISHOP, LINDSAY K JR (PA)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:K
Last Name:BISHOP
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE ROAD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-824-3737
Mailing Address - Fax:888-687-6133
Practice Address - Street 1:10400 RAMSEY WAY
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055
Practice Address - Country:US
Practice Address - Phone:615-824-3737
Practice Address - Fax:888-295-0304
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA11363A00000X
363A00000X
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4147345OtherBCBS PIN
P00400955OtherRAILROAD MEDICARE PIN
P00393942OtherRAILROAD MEDICARE
TN36650531Medicaid
TN4147345OtherBCBS PIN
P00400955OtherRAILROAD MEDICARE PIN
P00393942OtherRAILROAD MEDICARE