Provider Demographics
NPI:1265777460
Name:FISHER, KRISTINA (MSN,CNS)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MSN,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 GLENWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4080
Mailing Address - Country:US
Mailing Address - Phone:937-654-4642
Mailing Address - Fax:
Practice Address - Street 1:3095 KETTERING BLVD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1983
Practice Address - Country:US
Practice Address - Phone:937-293-8300
Practice Address - Fax:937-534-1579
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH348586364SP0807X
OHAPRN.CNS.15040364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092420Medicaid