Provider Demographics
NPI:1477743961
Name:FISHER, BETHANY S (NPC)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:S
Last Name:FISHER
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13200 SANTA ANA RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-7122
Mailing Address - Country:US
Mailing Address - Phone:415-555-1212
Mailing Address - Fax:223-257-7380
Practice Address - Street 1:13200 SANTA ANA RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-7122
Practice Address - Country:US
Practice Address - Phone:415-555-1212
Practice Address - Fax:223-257-7380
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11630OtherCA NURSE PRACTITIONER CERTIFICATE
CA520689OtherBOARD OF REGISTERED NURSES LICENSE
CAF1101057OtherAMERCIAN ACADEMY OF NURSE PRACTITIONER CERTIFICATE
CA11630OtherCA NURSE PRACTITIONER CERTIFICATE