MEDICARE: KAYLYN JOELLE FISHER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant		TX

General Provider Information

NPI Number	:	1023473204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLYN JOELLE FISHER PA-C

Provider Business Mailing Address
First Line	:	3901 W 15TH ST
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-7738
Country	:	US
Telephone Number	:	972-596-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7738
Country	:	US
Telephone Number	:	972-596-6800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	11/23/2020

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