Healthcare Provider Details

I. General information

NPI: 1740064690
Provider Name (Legal Business Name): KYLE ALEXANDER FISHER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MISSOURI AVE
JEFFERSONVILLE IN
47130-3743
US

IV. Provider business mailing address

1220 MISSOURI AVE
JEFFERSONVILLE IN
47130-3743
US

V. Phone/Fax

Practice location:
  • Phone: 812-283-2521
  • Fax:
Mailing address:
  • Phone: 812-283-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28214415A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: