Healthcare Provider Details

I. General information

NPI: 1598082489
Provider Name (Legal Business Name): MELINDA S BISHOP-HERRE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 07/03/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 MDG UNIT 3215 RAMSTEIN AB
APO AE
09094
US

IV. Provider business mailing address

86 MDG UNIT 3215 RAMSTEIN AB
APO AE
09094
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1098
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00127
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: