Healthcare Provider Details

I. General information

NPI: 1285410001
Provider Name (Legal Business Name): CHRISTOPHER GORDON BISHOP APRN-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 CROSSROADS BLVD STE 100
NORMAN OK
73072-3359
US

IV. Provider business mailing address

7509 NW 19TH ST
BETHANY OK
73008-5427
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-2715
  • Fax:
Mailing address:
  • Phone: 405-823-4109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number215034
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: