=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548748825
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIA BISHOP-TALL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2018
-----------------------------------------------------
Last Update Date | 08/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14523 WESTLAKE DR STE 25
-----------------------------------------------------
City | LAKE OSWEGO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97035-7700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-966-5660
-----------------------------------------------------
Fax | 503-713-5770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14925 SW BARROWS RD. STE 109 #137
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97007-7565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-966-5660
-----------------------------------------------------
Fax | 503-713-5770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JULIA C BISHOP-TALL
-----------------------------------------------------
Credential | DNP, PMHNP-BC
-----------------------------------------------------
Telephone | 206-697-0843
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------