Provider Demographics
NPI:1912703661
Name:BISHOP, AMY (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BISHOP
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 S 800 W
Mailing Address - Street 2:
Mailing Address - City:HEYBURN
Mailing Address - State:ID
Mailing Address - Zip Code:83336-9758
Mailing Address - Country:US
Mailing Address - Phone:208-421-0745
Mailing Address - Fax:
Practice Address - Street 1:472 S 800 W
Practice Address - Street 2:
Practice Address - City:HEYBURN
Practice Address - State:ID
Practice Address - Zip Code:83336-9758
Practice Address - Country:US
Practice Address - Phone:208-421-0745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID000666480390200000X
ID54949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program