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NPI Code Detail

MEDICARE: STACY L FISH PA-C

MEDICARE: STACY L FISH 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
1363A00000XPhysician AssistantPA-949ID
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1598063851
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY L FISH PA-C
Provider Business Mailing Address
First Line : PO BOX 190930
Second Line :
City : BOISE
State : ID
Zip : 83719-0930
Country : US
Telephone Number : 208-302-9342
Fax Number : 208-367-5180
Provider Business Practice Location Address
First Line : 712 AVIATION WAY
Second Line :
City : CALDWELL
State : ID
Zip : 83605-1154
Country : US
Telephone Number : 208-302-1400
Fax Number : 208-302-1455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2011
Last Update Date : 02/18/2026

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