Provider Demographics
NPI:1033651336
Name:FISK, IRMINA
Entity type:Individual
Prefix:
First Name:IRMINA
Middle Name:
Last Name:FISK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13310 LARSEN LN APT 203
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-3419
Mailing Address - Country:US
Mailing Address - Phone:619-792-4281
Mailing Address - Fax:
Practice Address - Street 1:325 N SAINT PAUL ST STE 3100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3923
Practice Address - Country:US
Practice Address - Phone:888-279-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2025-04-25
Deactivation Date:2023-11-05
Deactivation Code:
Reactivation Date:2023-12-22
Provider Licenses
StateLicense IDTaxonomies
CA95101694163WP0809X
KS53-82733-041363LP0808X
AZ308031363LP0808X
TX1162549363LP0808X
NY406241363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ308031OtherNP LICENSE
NY406241OtherNP LICENSE
TX1162549OtherNP LICENSE