Healthcare Provider Details

I. General information

NPI: 1639088164
Provider Name (Legal Business Name): LILY WAMBOLT BISHOP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 RIDGEPOINT CT
BATON ROUGE LA
70810-2876
US

IV. Provider business mailing address

968 RIDGEPOINT CT
BATON ROUGE LA
70810-2876
US

V. Phone/Fax

Practice location:
  • Phone: 225-244-1914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: