Provider Demographics
NPI:1043388044
Name:FISHER, KARI ANN (MPH, RD)
Entity Type:Individual
Prefix:MS
First Name:KARI
Middle Name:ANN
Last Name:FISHER
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8644 SE 75TH PL
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5704
Mailing Address - Country:US
Mailing Address - Phone:206-236-2450
Mailing Address - Fax:
Practice Address - Street 1:1916 BOREN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1467
Practice Address - Country:US
Practice Address - Phone:206-296-2752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000260133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8270027Medicaid
WA8270027Medicaid