Provider Demographics
NPI:1083185953
Name:FISHER, CASEY RYAN (CSFA, CST)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:RYAN
Last Name:FISHER
Suffix:
Gender:F
Credentials:CSFA, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOUSEFINCH LOOP
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-1961
Mailing Address - Country:US
Mailing Address - Phone:281-935-8500
Mailing Address - Fax:
Practice Address - Street 1:101 HOUSEFINCH LOOP
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1961
Practice Address - Country:US
Practice Address - Phone:281-935-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO185229246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO185229OtherNBSTSA