Basic Information
Provider Information | |||||||||
NPI: | 1912956202 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BISHOP | ||||||||
FirstName: | LINDSAY | ||||||||
MiddleName: | K | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | PA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BISHOP | ||||||||
OtherFirstName: | LINDSAY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 131 SAUNDERSVILLE ROAD | ||||||||
Address2: | SUITE 160 | ||||||||
City: | HENDERSONVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 37075 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6158243737 | ||||||||
FaxNumber: | 8886876133 | ||||||||
Practice Location | |||||||||
Address1: | 10400 RAMSEY WAY | ||||||||
Address2: |   | ||||||||
City: | DICKSON | ||||||||
State: | TN | ||||||||
PostalCode: | 37055 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6158243737 | ||||||||
FaxNumber: | 8882950304 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/06/2006 | ||||||||
LastUpdateDate: | 12/27/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA11 | TN | N |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   | 363A00000X |   |   | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   | 363A00000X |   | TN | N |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 4147345 | 01 | TN | BCBS PIN | OTHER | P00400955 | 01 |   | RAILROAD MEDICARE PIN | OTHER | P00393942 | 01 |   | RAILROAD MEDICARE | OTHER | 36650531 | 05 | TN |   | MEDICAID |