Provider Demographics
NPI:1932918240
Name:FISHLEY, KASEY JO (AGNP-C)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:JO
Last Name:FISHLEY
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:MINERAL CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44656-0453
Mailing Address - Country:US
Mailing Address - Phone:330-204-4608
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 453
Practice Address - Street 2:
Practice Address - City:MINERAL CITY
Practice Address - State:OH
Practice Address - Zip Code:44656-0453
Practice Address - Country:US
Practice Address - Phone:330-204-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0038313207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine