Healthcare Provider Details

I. General information

NPI: 1619085412
Provider Name (Legal Business Name): DAISY EILEEN FISHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE
JACKSON MS
39216-5116
US

IV. Provider business mailing address

1221 DEERFIELD LN
JACKSON MS
39211-3116
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-4471
  • Fax: 601-364-1357
Mailing address:
  • Phone: 601-956-9388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR561584
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: