Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 23101 | SC |
NPI | 1003455635 |
---|---|
Provider Name | Kimberly Brooke Bishop |
First Address | Greer, SC 29650-2400 |
Second Address | Greer, SC 29650-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2019 |
Last Update Date | 30/12/2019 |