Provider Demographics
NPI:1992703383
Name:FISCHBACH, CANDY SUE (PA-C)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:SUE
Last Name:FISCHBACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 HOGARTH DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5748
Mailing Address - Country:US
Mailing Address - Phone:502-931-5231
Mailing Address - Fax:
Practice Address - Street 1:1228 HOGARTH DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5748
Practice Address - Country:US
Practice Address - Phone:502-931-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA 369363AM0700X
KYPA369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000246341OtherANTHEM
KY0789303Medicare ID - Type Unspecified