Provider Demographics
NPI:1568076024
Name:FISHER, ROGER (APRN)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TERAVISTA PKWY APT 918
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1298
Mailing Address - Country:US
Mailing Address - Phone:512-850-0923
Mailing Address - Fax:
Practice Address - Street 1:401 TERAVISTA PKWY APT 918
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1298
Practice Address - Country:US
Practice Address - Phone:512-850-0923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily