Provider Demographics
NPI:1235168816
Name:FISHER, DIERDRE DENISE (RN, APRN, BC, CNSPMH)
Entity Type:Individual
Prefix:
First Name:DIERDRE
Middle Name:DENISE
Last Name:FISHER
Suffix:
Gender:F
Credentials:RN, APRN, BC, CNSPMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 ENERO PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-0934
Mailing Address - Country:US
Mailing Address - Phone:210-694-0625
Mailing Address - Fax:800-853-9536
Practice Address - Street 1:616 W RUSSELL PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3658
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX627372364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89N424OtherBLUE CROSS BLUE SHIELD
TXP00108424OtherRAILROAD
TX148814002Medicaid
TX89N424OtherBLUE CROSS BLUE SHIELD