Individual
THERESA LANE FISHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
4436 NORTH STATE STREET, SUITE AI, JACKSON, MS 39206-3073
(769) 257-5336
(769) 257-5339
Mailing address
4436 NORTH STATE STREET, SUITE AI, JACKSON, MS 39206-3073
(769) 257-5336
(769) 257-5339
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA011
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125523
—
MS
Enumeration date
05/10/2007
Last updated
04/13/2012
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