Provider Demographics
NPI:1588131650
Name:FISHER, KILEY O'BRIEN (ARNP-C)
Entity type:Individual
Prefix:MRS
First Name:KILEY
Middle Name:O'BRIEN
Last Name:FISHER
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PATRICIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-8103
Mailing Address - Country:US
Mailing Address - Phone:727-733-4193
Mailing Address - Fax:813-635-2638
Practice Address - Street 1:180 PATRICIA AVE
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-8103
Practice Address - Country:US
Practice Address - Phone:727-733-4193
Practice Address - Fax:813-635-2638
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9376813363LF0000X
FLAPRN9376813363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107223400Medicaid