Provider Demographics
NPI:1487112850
Name:BISHOP, AUDREY LOUISE
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:LOUISE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ROBERTS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29626-6641
Mailing Address - Country:US
Mailing Address - Phone:864-612-9104
Mailing Address - Fax:
Practice Address - Street 1:211 ROBERTS CHURCH RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29626-6641
Practice Address - Country:US
Practice Address - Phone:864-612-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator