Basic Information
| Provider Information | |||||||||
| NPI: | 1457901092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISHOP | ||||||||
| FirstName: | KASSIDY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | WHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N SUMMIT ST FL 7 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198241785 | ||||||||
| FaxNumber: | 4198245953 | ||||||||
| Practice Location | |||||||||
| Address1: | 5308 HARROUN RD # 285 | ||||||||
| Address2: | |||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198241785 | ||||||||
| FaxNumber: | 4198245953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2019 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN.CNP.025629 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.