Healthcare Provider Details

I. General information

NPI: 1760798425
Provider Name (Legal Business Name): MRS. RHONDA FAY FISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 8TH ST
CLARKSVILLE TN
37040-3093
US

IV. Provider business mailing address

1903 CALVIN DR. APTB
HOPKINSVILLE KY
42240-5005
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7240
  • Fax: 931-920-7205
Mailing address:
  • Phone: 270-885-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: