Healthcare Provider Details

I. General information

NPI: 1033651336
Provider Name (Legal Business Name): IRMINA FISK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date: 11/05/2023
Reactivation Date: 12/22/2023

III. Provider practice location address

325 N SAINT PAUL ST STE 3100
DALLAS TX
75201-3923
US

IV. Provider business mailing address

13310 LARSEN LN APT 203
OVERLAND PARK KS
66213-3419
US

V. Phone/Fax

Practice location:
  • Phone: 888-279-0002
  • Fax:
Mailing address:
  • Phone: 619-792-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95101694
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-82733-041
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number308031
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1162549
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: