Provider Demographics
NPI:1790738326
Name:FISHER, MONICA LYNN (PA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNN
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:LYNN
Other - Last Name:MCCLOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:222 N 6THST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502
Mailing Address - Country:US
Mailing Address - Phone:785-565-2936
Mailing Address - Fax:785-565-2969
Practice Address - Street 1:222 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6057
Practice Address - Country:US
Practice Address - Phone:785-565-2936
Practice Address - Fax:785-565-2959
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100335720NMedicaid
KS553A00077Medicare PIN
KS100335720NMedicaid