Provider Demographics
NPI:1699451179
Name:FIKE, LIBERTY
Entity type:Individual
Prefix:
First Name:LIBERTY
Middle Name:
Last Name:FIKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 COUNTY ROAD 31
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9656
Mailing Address - Country:US
Mailing Address - Phone:260-570-8060
Mailing Address - Fax:
Practice Address - Street 1:5419 COUNTY ROAD 427
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-9504
Practice Address - Country:US
Practice Address - Phone:833-338-6946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013472A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner