Provider Demographics
NPI:1790882314
Name:FISCHELS, SUSAN A (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:FISCHELS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:227 RIVERSTONE DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5256
Practice Address - Country:US
Practice Address - Phone:770-720-7733
Practice Address - Fax:770-720-7557
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN298285367A00000X
KY4282M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4282MOtherLICENSE
000000329595OtherBCBS PIN
KY78011624Medicaid
Q11944Medicare UPIN
000000329595OtherBCBS PIN
KY4282MOtherLICENSE
KYP00148304Medicare PIN
KYK008640Medicare PIN