Provider Demographics
NPI:1912952813
Name:FISTER, CYNTHIA M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:M
Last Name:FISTER
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 1:315 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1703
Mailing Address - Country:US
Mailing Address - Phone:502-629-2500
Mailing Address - Fax:502-629-3166
Practice Address - Street 1:131 STONECREST RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-9191
Practice Address - Country:US
Practice Address - Phone:502-633-7093
Practice Address - Fax:502-633-7094
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2762P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50013809OtherPASSPORT
KY78007382Medicaid
KYP00384338OtherRAILROAD MEDICARE
KY78007382Medicaid
KYP32058Medicare UPIN