MEDICARE: LAFAYETTE BISHOP NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	255497	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	255497	AZ

General Provider Information

NPI Number	:	1588387989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAFAYETTE BISHOP NP

Provider Business Mailing Address
First Line	:	11070 N 24TH AVE STE 250
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4705
Country	:	US
Telephone Number	:	602-795-8795
Fax Number	:

Provider Business Practice Location Address
First Line	:	11070 N 24TH AVE STE 250
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4705
Country	:	US
Telephone Number	:	602-795-8795
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	06/01/2025

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