Healthcare Provider Details

I. General information

NPI: 1447424734
Provider Name (Legal Business Name): JENNIFER EVINS BISHOP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 PRINCE ST STE 43
CONWAY AR
72034-3600
US

IV. Provider business mailing address

2850 PRINCE ST STE 43
CONWAY AR
72034-3600
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-6665
  • Fax:
Mailing address:
  • Phone: 501-327-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE-7557
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: