Healthcare Provider Details

I. General information

NPI: 1891617866
Provider Name (Legal Business Name): JESSICA BISHOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 PEARL BEACH BLVD
CLAY MI
48001-4272
US

IV. Provider business mailing address

9330 PEARL BEACH BLVD
CLAY MI
48001-4272
US

V. Phone/Fax

Practice location:
  • Phone: 586-651-0882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704358725
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: