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General NPI Number Information
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NPI Number | 1104415454
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Entity Type | Individual
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Provider Name | ANGELIQUE LAVONNE BISHOP APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 1038 EARLY BLVD
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City | EARLY
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State | TX
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Zip | 76802-2211
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Country | US
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Telephone | 325-646-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 COUNTY ROAD 139
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City | BANGS
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State | TX
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Zip | 76823-3822
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Country | US
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Telephone | 325-998-1119
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1018731
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License Number State | TX
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