MEDICARE: MISS KIMBERLY ROSE FISHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		OK

General Provider Information

NPI Number	:	1962514109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIMBERLY ROSE FISHER

Provider Business Mailing Address
First Line	:	1203 HAYES AVE
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-3952
Country	:	US
Telephone Number	:	580-323-8409
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 HAYES AVE
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-3952
Country	:	US
Telephone Number	:	580-323-8409
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/27/2007

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Directions to “ MISS KIMBERLY ROSE FISHER ” Practice Location

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