Provider Demographics
NPI:1285143875
Name:BISHOP, KEVIN BLAKE (APRN NP-C)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:BLAKE
Last Name:BISHOP
Suffix:
Gender:M
Credentials:APRN NP-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1500 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-9663
Mailing Address - Country:US
Mailing Address - Phone:606-547-5395
Mailing Address - Fax:606-547-5395
Practice Address - Street 1:1600 MEDICAL CENTER DR STE 1500
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3657
Practice Address - Country:US
Practice Address - Phone:304-691-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3011515363L00000X
WV104052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3011515OtherKENTUCKY BOARD OF NURSING