Healthcare Provider Details

I. General information

NPI: 1992441562
Provider Name (Legal Business Name): ALEXIS NIKALE FISHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SPRINGFIELD DR
CHICO CA
95928-5995
US

IV. Provider business mailing address

11542 S SANDERS RD
SANDY UT
84094-5614
US

V. Phone/Fax

Practice location:
  • Phone: 530-781-1440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11437707-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: