Basic Information
| Provider Information | |||||||||
| NPI: | 1184112138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISE | ||||||||
| FirstName: | KINSEY | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E BROAD STREET | ||||||||
| Address2: | WEST HOSPITAL, 8TH FLOOR | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048284570 | ||||||||
| FaxNumber: | 8048284614 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 E. MARSHALL ST | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048289000 | ||||||||
| FaxNumber: | 8048284614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2018 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 0101267546 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.