Basic Information
| Provider Information | |||||||||
| NPI: | 1528563178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | KASYN | ||||||||
| MiddleName: | DELYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 BARNES RD | ||||||||
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| City: | MEDINA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383558682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316140896 | ||||||||
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| Practice Location | |||||||||
| Address1: | 620 SKYLINE DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315415000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0000194536 | TN | N | Nursing Service Providers | Registered Nurse | 367500000X | 24468 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.