Provider Demographics
NPI:1255750907
Name:FISHER, ASHLY NICOLE (DO)
Entity type:Individual
Prefix:
First Name:ASHLY
Middle Name:NICOLE
Last Name:FISHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ASHLY
Other - Middle Name:N
Other - Last Name:DUCHARME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:636-549-0121
Mailing Address - Fax:
Practice Address - Street 1:20 THE LEGENDS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3825
Practice Address - Country:US
Practice Address - Phone:636-549-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020028268207R00000X
MI5101021407207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine