Individual
KELLEY BISHOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
(601) 984-6811
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
(601) 984-6811
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16770
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0122139
—
MS
01
—
302I080477
MEDICARE PTAN
MS
01
—
P01245547
RAILROAD MEDICARE
MS
Enumeration date
07/25/2006
Last updated
10/02/2023
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