Healthcare Provider Details

I. General information

NPI: 1568384162
Provider Name (Legal Business Name): LAURA ANN BISHOP MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11937 U.S. 271
TYLER TX
75708
US

IV. Provider business mailing address

5120 WILDWOOD DR
BEAUMONT TX
77708-3926
US

V. Phone/Fax

Practice location:
  • Phone: 903-877-5025
  • Fax:
Mailing address:
  • Phone: 409-673-6856
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: