Provider Demographics
NPI:1326411109
Name:FISHER, KIRK
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MARKET ST STE 109
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6321
Mailing Address - Country:US
Mailing Address - Phone:570-720-0275
Mailing Address - Fax:570-720-0276
Practice Address - Street 1:460 MARKET ST STE 109
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6321
Practice Address - Country:US
Practice Address - Phone:570-720-0275
Practice Address - Fax:570-720-0276
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA284636013747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant