Healthcare Provider Details

I. General information

NPI: 1629578273
Provider Name (Legal Business Name): ORLESHA CARROLL BISHOP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E RIVER PL
JACKSON MS
39202-3486
US

IV. Provider business mailing address

110 GREEN GATE XING
RIDGELAND MS
39157-9711
US

V. Phone/Fax

Practice location:
  • Phone: 601-500-7660
  • Fax: 769-243-7946
Mailing address:
  • Phone: 601-259-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number902200
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: