Individual
TYLER FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5430 MACCORKLE AVE SE, CHARLESTON, WV 25304-2224
(304) 925-3627
Mailing address
308 JK LN, KENNA, WV 25248-7280
(304) 532-5435
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1944
WV
Other
Enumeration date
11/10/2015
Last updated
11/10/2015
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