Provider Demographics
NPI:1205860368
Name:FISCO, PATRICIA KLINE (CNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KLINE
Last Name:FISCO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 HEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1114
Mailing Address - Country:US
Mailing Address - Phone:740-709-1091
Mailing Address - Fax:740-446-6813
Practice Address - Street 1:422 HEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1114
Practice Address - Country:US
Practice Address - Phone:740-709-1091
Practice Address - Fax:740-446-6813
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP05961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2415863Medicaid
NP12883Medicare ID - Type Unspecified
OH2415863Medicaid