Provider Demographics
NPI:1720556848
Name:FISHER, JESSICA ANNA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNA
Last Name:FISHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25320-9717
Mailing Address - Country:US
Mailing Address - Phone:304-859-4459
Mailing Address - Fax:
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 509
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1226
Practice Address - Country:US
Practice Address - Phone:304-342-0821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN83384-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily