Provider Demographics
NPI:1003473695
Name:FISHER, NICHOLAS COLTON (FNP)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:COLTON
Last Name:FISHER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 GRAMMONT ST.
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7516
Mailing Address - Country:US
Mailing Address - Phone:318-325-2634
Mailing Address - Fax:318-812-1205
Practice Address - Street 1:611 GRAMMONT ST.
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7516
Practice Address - Country:US
Practice Address - Phone:318-325-2634
Practice Address - Fax:318-812-1205
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily