Provider Demographics
NPI:1992146088
Name:BISHOP, KELLIE A (APRN)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:A
Last Name:BISHOP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-4082
Practice Address - Street 1:9015 DAILEY DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-6215
Practice Address - Country:US
Practice Address - Phone:501-364-6560
Practice Address - Fax:501-364-1236
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2022-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARR093565163W00000X
ARA004760363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR214659758Medicaid