MEDICARE: MICHELLE K FLETES FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP119591	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477853943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE K FLETES FNP

Provider Business Mailing Address
First Line	:	4101 E 42ND ST
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79762-7239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 E 42ND ST
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79762-7239
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	12/15/2021

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