Provider Demographics
NPI:1447612601
Name:FISHER, ANDREA J (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:FISHER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 BLACK ROCK LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7831
Mailing Address - Country:US
Mailing Address - Phone:573-330-2822
Mailing Address - Fax:866-678-4281
Practice Address - Street 1:1945 LAKEPOINTE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-6469
Practice Address - Country:US
Practice Address - Phone:800-835-2362
Practice Address - Fax:666-784-2818
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK219309363LF0000X
DCNP500016675363LF0000X
AZ306329363LF0000X
COC-APN.0101735-C-NP363LF0000X
DELG-0012657363LF0000X
FLAPRN11031179363LF0000X
GU100243363LF0000X
HIAPRN-4489363LF0000X
IAA177861363LF0000X
ID78685363LF0000X
IL209029828363LF0000X
KS53-82883-082363LF0000X
MDAC006363363LF0000X
MECNP241050363LF0000X
MO2015042085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT101.0136841OtherSTATE LICENSE
UT13744780-4405OtherSTATE LICENSE
NV875106OtherSTATE LICENSE
NDR55573OtherSTATE LICENSE
WY53811OtherSTATE LICENSE
VA0024189313OtherSTATE LICENSE
NM77490OtherSTATE LICENSE
OR10021708OtherSTATE LICENSE
NE115207OtherSTATE LICENSE
WAAP61517963OtherSTATE LICENSE
MTAPRN-235559OtherSTATE LICENSE
MN11367OtherNP STATE LICENSE
RIAPRN04007OtherSTATE LICENSE
SDCP003126OtherSTATE LICENSE