Basic Information
| Provider Information | |||||||||
| NPI: | 1285143875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISHOP | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | BLAKE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | APRN NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 HIGHVIEW DR | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411029663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065475395 | ||||||||
| FaxNumber: | 6065475395 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 MEDICAL CENTER DR STE 1500 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2017 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3011515 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 104052 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 3011515 | 01 | KY | KENTUCKY BOARD OF NURSING | OTHER |