Provider Demographics
NPI:1114463809
Name:FISHER, KINSEY (FNP)
Entity Type:Individual
Prefix:
First Name:KINSEY
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KINSEY
Other - Middle Name:
Other - Last Name:LEISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 S 3RD ST W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2321
Mailing Address - Country:US
Mailing Address - Phone:406-214-2040
Mailing Address - Fax:888-700-9240
Practice Address - Street 1:1101 S 3RD ST W
Practice Address - Street 2:SUITE 101
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2321
Practice Address - Country:US
Practice Address - Phone:406-214-2040
Practice Address - Fax:888-700-9240
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT124191363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care