People have traditionally relied on fish to supply their major food and healthcare needs all across the world. However, there has been little focus on the traditional dietary, cultural identity, and integrity of traditional food systems in many rural Himalayan populations. The current study looks into the use of fish in traditional food and foraging practices, as well as its role in local traditional medicine and cultural practices. Semi-structured interviews and group discussions were used to collect data in the years 2020–2021. The data were analyzed using various statistical indices such as the fidelity level (FL), rank order priority (ROP), and relative popularity level (RPL). The data were then classified through a heat map, and ordination techniques were used to refine them even further. The current study identified 20 fish species of five families, with Cyprinidae (70%) as the dominant family. Three unique traditional fish preservation techniques were documented, namely: (1) smoking, (2) sun drying, and (3) pickling. The smoked fish are locally called fari, sun-dried fish are known as hugaad, and pickled fish are gaad anchaar. As a result of rapid modernization, fish has become a symbol of social class in the valley. In total, 17 diseases were identified, with joint pain being treated by the greatest number of species (N = 10). Flesh (43%) was the most commonly used part to treat various diseases. The mode of application of various fishbody parts for treating a variety of diseases was most commonly peroral (65%), followed by topical (35%). Schizopyge niger demonstrated the highest level of fidelity (82%) for joint pain. Schizopygeniger, Schizothorax curvifrons, Catla catla, Schizothorax esocinus, Schizothorax labiatus, and Schizothorax plagiostomus were the most popular (relative popularity level = 1.0). The rank order priority of six species was above 55 (Schizothorax plagiostomus (59.18), Labeo dyocheilus (61.99) Schizothorax labiatus (64.28), Schizothorax esocinus (68.36), Schizothorax curvifrons (73.19), and Schizopyge niger (82)). Two principal groups of six ethno-zoological categories (medicine, food, black magic, poultry, agricultural, and recreational) were identified using cluster analysis. Fish are also important as a source of livelihood and are closely associated with a local ethnic group known as Hanji/Haanz, who have extensive knowledge of ecology of the local fish species. Our research will contribute to filling a knowledge gap in the Kashmir Himalayan region, with policy implications for the protection and preservation of high-quality traditional knowledge for future generations. The findings of this documentation study can be used as an ethnopharmacological foundation for selecting fish in future pharmaceutical research.