Provider Demographics
NPI:1194264614
Name:BISHOP, JAMIE (FNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:3201 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6901
Practice Address - Country:US
Practice Address - Phone:903-723-0330
Practice Address - Fax:903-723-3259
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1E3025OtherMCR PIN - JVILLE
TX379089102Medicaid
TXP02503119OtherMEDICARE RAILROAD
TX574424YMAFOtherMCR PIN - CTC
TX379089101-CTCMedicaid