Provider Demographics
NPI:1922494038
Name:FISHER, NISSA (RN, MSN, FNP-C, CCRN)
Entity Type:Individual
Prefix:
First Name:NISSA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 W 110TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1501
Mailing Address - Country:US
Mailing Address - Phone:913-303-0235
Mailing Address - Fax:
Practice Address - Street 1:6650 W 110TH ST STE 210
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1501
Practice Address - Country:US
Practice Address - Phone:913-558-0058
Practice Address - Fax:913-871-6412
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-106534-101163WG0000X
MO2006030418163WG0000X
MO2015004538363LF0000X
KS53-76731-101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG93000053Medicare PIN
MOH74000030Medicare PIN