Healthcare Provider Details

I. General information

NPI: 1649920703
Provider Name (Legal Business Name): JODY L BISHOP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 DEXTER AVE STE 4050
MONTGOMERY AL
36104-3867
US

IV. Provider business mailing address

738 SHELBY FOREST TRL
CHELSEA AL
35043-5527
US

V. Phone/Fax

Practice location:
  • Phone: 855-479-4217
  • Fax: 888-557-9724
Mailing address:
  • Phone: 205-440-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1-176780
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-176780
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-176780
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: