Basic Information
Provider Information
NPI: 1457742132
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FISHER
FirstName: RACHEL
MiddleName: DUNCAN
NamePrefix: MRS.
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1169 EASTERN PKWY
Address2: STE G58
City: LOUISVILLE
State: KY
PostalCode: 402171472
CountryCode: US
TelephoneNumber: 5024529567
FaxNumber: 5024730586
Practice Location
Address1: 1169 EASTERN PKWY
Address2: STE G58
City: LOUISVILLE
State: KY
PostalCode: 402171472
CountryCode: US
TelephoneNumber: 5024529567
FaxNumber: 5024730586
Other Information
ProviderEnumerationDate: 02/17/2015
LastUpdateDate: 05/07/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X3008970KYN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363L00000X3008970KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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