Healthcare Provider Details

I. General information

NPI: 1285351858
Provider Name (Legal Business Name): DAVONNA MARIE KORNAGAY FLETCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAVONNA MARIE FLETCHER

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 YUBA ST
MARYSVILLE CA
95901-4831
US

IV. Provider business mailing address

1128 YUBA ST
MARYSVILLE CA
95901-4831
US

V. Phone/Fax

Practice location:
  • Phone: 530-418-1001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: