Provider Demographics
NPI:1023601879
Name:FISHER-WILLIS, ADRIANNA RENEE
Entity type:Individual
Prefix:DR
First Name:ADRIANNA
Middle Name:RENEE
Last Name:FISHER-WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11062
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40512-1062
Mailing Address - Country:US
Mailing Address - Phone:630-408-0611
Mailing Address - Fax:
Practice Address - Street 1:1804 STOCKTON WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2269
Practice Address - Country:US
Practice Address - Phone:630-408-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2022-04-01
Deactivation Date:2021-12-16
Deactivation Code:
Reactivation Date:2022-04-01
Provider Licenses
StateLicense IDTaxonomies
KY268837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical