Kelli M Bishop, PSY.D.
Individual provider Active NPI Clinical Psychologist · Idaho Falls, ID
NPI 1164542585 · NPPES record last updated Jul 25, 2016
Key facts
- NPI
- 1164542585
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY-202640 (ID)
- Practice address
- 111 E 16TH St
Idaho Falls, ID 83404-5919 - Phone
- (208) 523-1130
- NPI assigned
- Mar 30, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-202640 | ID | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY-202640 | ID | Yes |
Addresses
Primary practice location
111 E 16TH St
Idaho Falls, ID 83404-5919
Mailing address
4255 Wade Green Rd NW
Ste 414
Kennesaw, GA 30144-1763
Phone (678) 213-2194
Other providers in Idaho Falls, ID
- Rebekah J Bird
- Taylor Bird
- Hilary Birdwell
- Jamesen Birkel
- McKayla Bisbee
- Matthew Allen Bishop
- Raelene Ann Bishop
- Bruce N Bjornson
- Joshua Phillip Black
- Matthew David Black
All providers in Idaho Falls, ID · Clinical Psychologist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.