Basic Information
| Provider Information | |||||||||
| NPI: | 1821571514 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | SIERRA | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 WILLIAM H JOHNSON ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436671891 | ||||||||
| FaxNumber: | 8436652516 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 WILLIAM H. JOHNSON STREET | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436671891 | ||||||||
| FaxNumber: | 8436652516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2018 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 22192 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 22192 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | NP5559 | 05 | SC | MEDICAID |