MEDICARE: MRS. NICOLE INGEBRETSEN BISHOP FNP-C

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	163W00000X	Registered Nurse	849248	TX
2	363LF0000X	Family Nurse Practitioner	AP136534	TX

General Provider Information

NPI Number	:	1811479165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE INGEBRETSEN BISHOP FNP-C

Provider Business Mailing Address
First Line	:	5903 DORSEY DR
Second Line	:
City	:	MAGNOLIA
State	:	TX
Zip	:	77354-2322
Country	:	US
Telephone Number	:	832-335-5370
Fax Number	:

Provider Business Practice Location Address
First Line	:	15555 KUYKENDAHL RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3651
Country	:	US
Telephone Number	:	713-462-6565
Fax Number	:

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

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	12/06/2023

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