Provider Demographics
NPI:1043797905
Name:FISHGOLD, KARA A (NP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:A
Last Name:FISHGOLD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 N 19TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2451
Mailing Address - Country:US
Mailing Address - Phone:602-589-0500
Mailing Address - Fax:602-314-4552
Practice Address - Street 1:5501 N 19TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2451
Practice Address - Country:US
Practice Address - Phone:602-589-0500
Practice Address - Fax:602-314-4552
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11151363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care