Healthcare Provider Details

I. General information

NPI: 1912703661
Provider Name (Legal Business Name): AMY BISHOP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 S 800 W
HEYBURN ID
83336-9758
US

IV. Provider business mailing address

472 S 800 W
HEYBURN ID
83336-9758
US

V. Phone/Fax

Practice location:
  • Phone: 208-421-0745
  • Fax:
Mailing address:
  • Phone: 208-421-0745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number54949
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number000666480
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4171665
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: