Lane Fisher, Theresa

Lane Fisher, Theresa is an sole proprietor health care provider with primary practice located at 4436 North State Street, Suite Ai , Jackson MS 39206-3073. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Lane Fisher, Theresa can be contacted via phone (769) 257-5336.

Contact Information

Primary practice address
4436 North State Street, Suite Ai Jackson MS 39206-3073
Phone: (769) 257-5336
Fax: (769) 257-5339
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA011 Mississippi

Profile Details

NPI number 1780898577
LBN Legal business name Lane Fisher, Theresa
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 10th, 2007
Last updated Apr 13th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780898577 NPPES
Mississippi MEDICAID 00125523

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