Provider Demographics
NPI:1316183593
Name:FISHER, KATHY LYNN (LAC)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:LYNN
Last Name:FISHER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 S. GLORIA LN.
Mailing Address - Street 2:
Mailing Address - City:CORNVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86325-5535
Mailing Address - Country:US
Mailing Address - Phone:928-634-1407
Mailing Address - Fax:
Practice Address - Street 1:851 S. MAIN STREET
Practice Address - Street 2:SUITE C
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4634
Practice Address - Country:US
Practice Address - Phone:928-634-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0532171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist