Provider Demographics
NPI:1740987544
Name:FISHER, TERRELL MATTHEW
Entity type:Individual
Prefix:MR
First Name:TERRELL
Middle Name:MATTHEW
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10308 SAINT ANN LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-3523
Mailing Address - Country:US
Mailing Address - Phone:314-885-5261
Mailing Address - Fax:
Practice Address - Street 1:10308 SAINT ANN LN
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-3523
Practice Address - Country:US
Practice Address - Phone:314-885-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care