Kelly L Bishop-Diaz, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

513 Issued in ND

Practice address

2285 Star S Ave
Grand Forks, ND 58201-3478

Phone

(701) 330-8210

Fax

(701) 330-8210

NPI assigned

Dec 13, 2006

Last updated

Sep 3, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN, ND2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441238400000",
    "number": "1891856860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 STAR S AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013478",
            "telephone_number": "701-330-8210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2285 STAR S AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013478",
            "telephone_number": "701-330-8210",
            "fax_number": "701-330-8210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISHOP-DIAZ",
        "first_name": "KELLY",
        "middle_name": "L",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2015-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ND",
            "license": "513",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "2616",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TN",
            "identifier": "4107555",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justin Bina
• Bio-Medical Applications of Minnesota Inc (Fresenius Kidney Care Grand Forks)
• Lindsay Birke
• Margaret Mae Birkholz, RN
• George Birkmaier
• Robert Bishop
• Mohamad Zouheir Bitar, MD
• Michael Bitzan
• Jeffrey Scott Bjerke, ATC
• Sara Elizabeth Bjerke, ATC

• Clinical Psychologist in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Clinical Psychologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.