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General NPI Number Information
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NPI Number | 1629578273
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Entity Type | Individual
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Provider Name | ORLESHA CARROLL BISHOP FNP
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Gender | Female
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 805 E RIVER PL
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City | JACKSON
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State | MS
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Zip | 39202-3486
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Country | US
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Telephone | 601-500-7660
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Fax | 769-243-7946
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Provider Business Mailing Address
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Address Line | 110 GREEN GATE XING
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City | RIDGELAND
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State | MS
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Zip | 39157-9711
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Country | US
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Telephone | 601-259-3016
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 902200
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License Number State | MS
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