Provider Demographics
NPI:1770046005
Name:FISHER, KELLY ANN (WHNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:FISHER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:LASSITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1661 E CAMELBACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3913
Mailing Address - Country:US
Mailing Address - Phone:602-422-9000
Mailing Address - Fax:602-556-5951
Practice Address - Street 1:7950 KIPLING ST STE 201
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-3926
Practice Address - Country:US
Practice Address - Phone:303-424-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994532-NP363LW0102X
AZ273617363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ121693Medicaid