1821385030 NPI number — MRS. MEGHAN WALSH BISHOP ARNP

Table of content: MRS. MEGHAN WALSH BISHOP ARNP (NPI 1821385030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821385030 NPI number — MRS. MEGHAN WALSH BISHOP ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISHOP
Provider First Name:
MEGHAN
Provider Middle Name:
WALSH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821385030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1102 A1A N
Provider Second Line Business Mailing Address:
UNIT 104
Provider Business Mailing Address City Name:
PONTE VEDRA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32082-4098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-273-6533
Provider Business Mailing Address Fax Number:
904-273-6532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1633 RACE TRACK RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32259-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-287-7000
Provider Business Practice Location Address Fax Number:
904-460-2212
Provider Enumeration Date:
07/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  ARNP9219966 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1821385030 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114104800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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