Provider Demographics
NPI:1659084028
Name:FISHER, KAELYN LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KAELYN
Middle Name:LEE
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17260 LOSILLAS CIR UNIT 302
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9580
Mailing Address - Country:US
Mailing Address - Phone:904-422-5970
Mailing Address - Fax:
Practice Address - Street 1:17260 LOSILLAS CIR UNIT 302
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9580
Practice Address - Country:US
Practice Address - Phone:904-422-5970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant