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:
Health care specialties
| Specialty | Code | License # | 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 12 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780898577 | NPPES |
| Mississippi | MEDICAID | 00125523 |
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