Active NPI
Cynthia B Fish, APN
- Nurse Practitioner
- Jackson, TN
National Provider Identifier
1295704666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- APN5501
- Practice address
- 29 N Star Dr
Suite C
Jackson, TN 38305-6656 - Phone
- (731) 664-7949
- Fax
- (731) 664-6141
- NPI assigned
- Mar 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APN5501 | TN | Primary |
Addresses
Primary practice location
29 N Star Dr
Suite C
Jackson, TN 38305-6656
Mailing address
PO Box 10266
Jackson, TN 38308-0104
Phone (731) 664-7949
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q010795 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APN5501 | TN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427241600000",
"number": "1295704666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10266",
"city": "JACKSON",
"state": "TN",
"postal_code": "383080104",
"telephone_number": "731-664-7949",
"fax_number": "731-664-6141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29 N STAR DR",
"address_2": "SUITE C",
"city": "JACKSON",
"state": "TN",
"postal_code": "383056656",
"telephone_number": "731-664-7949",
"fax_number": "731-664-6141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISH",
"first_name": "CYNTHIA",
"middle_name": "B",
"credential": "APN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-16",
"last_updated": "2015-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "TN",
"license": "APN5501",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q010795",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Jackson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.