Provider Demographics
NPI:1205890142
Name:FISHER, SHEILA D (ARNP)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:D
Last Name:FISHER
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:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1325
Mailing Address - Country:US
Mailing Address - Phone:606-526-8131
Mailing Address - Fax:606-528-8661
Practice Address - Street 1:14949 N US HIGHWAY 25 E
Practice Address - Street 2:SUITE 4
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6285
Practice Address - Country:US
Practice Address - Phone:606-528-0305
Practice Address - Fax:606-523-4368
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4619P2083X0100X, 363L00000X
KY3004619363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78015880Medicaid
KYP01438254OtherRR MCR
KY78015880Medicaid