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General NPI Number Information
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NPI Number | 1033651336
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Entity Type | Individual
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Provider Name | IRMINA FISK
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Gender | Female
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 325 N SAINT PAUL ST STE 3100
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City | DALLAS
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State | TX
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Zip | 75201-3923
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Country | US
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Telephone | 888-279-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 13310 LARSEN LN APT 203
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City | OVERLAND PARK
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State | KS
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Zip | 66213-3419
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Country | US
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Telephone | 619-792-4281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 95101694
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 53-82733-041
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 308031
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1162549
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 406241
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License Number State | NY
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