Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Douglas R Bishop

Individual provider Registered Nurse · NPI 1417353608

Douglas R Bishop is a Nurse Practitioner in Poplar Bluff, Missouri. Qualified in 2014, 12 years ago. Practices with Southeastern Physician Services PC, a 598-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
12
Licensed in
MO
In the registry since
2014
Specialties on file
3
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Practice location Address checks out

2865 James Blvd
Poplar Bluff, MO 63901-2803
Phone: (573) 776-1100
Fax: (573) 776-1107
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence 2014038385 (MO)
Registered Nurse Taxonomy 163W00000X · Licence 2009003804 (MO)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence 2014038385 (MO)

Record details

NPI number1417353608
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedNovember 14, 2014
Last updated in NPPESNovember 14, 2014
Mailing address190 Industrial Dr, Festus, MO 63028-4133

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Southeastern Physician Services Pc — 598 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Poplar Bluff