Provider Demographics
NPI:1053355818
Name:FISHER, CARA D (PA)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:D
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:D
Other - Last Name:DRENNAN-FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MERCY WAY
Mailing Address - Street 2:STE 440
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-781-4404
Mailing Address - Fax:417-781-5845
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:STE 440
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-781-4404
Practice Address - Fax:417-781-5845
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011034658363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100349380IMedicaid
OK100198190AMedicaid
OK100198190AMedicaid
MOMA2082247Medicare PIN