Provider Demographics
NPI:1275022063
Name:FISHER, ASHTON JO
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:JO
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 N REDMOND AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4156
Mailing Address - Country:US
Mailing Address - Phone:405-201-0416
Mailing Address - Fax:
Practice Address - Street 1:3601 N REDMOND AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4156
Practice Address - Country:US
Practice Address - Phone:405-201-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator