Individual
IVY Q BISHOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 MEDICAL DR, LAKE JACKSON, TX 77566-5674
(979) 297-4411
Mailing address
4835 LBJ FWY, DALLAS, TX 75244-6005
(469) 420-5529
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA09329
TX
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/11/2014
Last updated
09/24/2024
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