Healthcare Provider Details

I. General information

NPI: 1487451555
Provider Name (Legal Business Name): LEVI DANIEL FISHER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 NEELY RD.
FORT WAINWRIGHT AK
99703
US

IV. Provider business mailing address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703
US

V. Phone/Fax

Practice location:
  • Phone: 719-440-6166
  • Fax:
Mailing address:
  • Phone: 907-361-6028
  • Fax: 907-361-4847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6781
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: