Healthcare Provider Details

I. General information

NPI: 1629764378
Provider Name (Legal Business Name): SAVANNAH NETHERTON FISTER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 SIR BARTON WAY STE 250
LEXINGTON KY
40509-2745
US

IV. Provider business mailing address

2530 SIR BARTON WAY STE 250
LEXINGTON KY
40509-2745
US

V. Phone/Fax

Practice location:
  • Phone: 859-639-0030
  • Fax: 859-639-0031
Mailing address:
  • Phone: 859-639-0030
  • Fax: 859-639-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06403
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: