Basic Information
Provider Information
NPI: 1033557483
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BISHOP
FirstName: KAYLIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2740 COLLEGE AVE
Address2:  
City: CONWAY
State: AR
PostalCode: 720346141
CountryCode: US
TelephoneNumber: 5013295459
FaxNumber: 5013271738
Practice Location
Address1: 2740 COLLEGE AVE
Address2:  
City: CONWAY
State: AR
PostalCode: 720346141
CountryCode: US
TelephoneNumber: 5013295459
FaxNumber: 5013271738
Other Information
ProviderEnumerationDate: 06/07/2013
LastUpdateDate: 06/07/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XR081961ARY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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