Healthcare Provider Details

I. General information

NPI: 1013645522
Provider Name (Legal Business Name): CAMILE YOLAN FLETCHER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 I ST
SACRAMENTO CA
95814-2400
US

IV. Provider business mailing address

2163 BRADBURN DR
SACRAMENTO CA
95835-2102
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-5222
  • Fax:
Mailing address:
  • Phone: 619-985-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95022019
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95052698
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number95022019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: