Healthcare Provider Details

I. General information

NPI: 1235834466
Provider Name (Legal Business Name): CHELSEA FLETCHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S 4TH ST
LEAVENWORTH KS
66048-5014
US

IV. Provider business mailing address

33955 227TH ST
EASTON KS
66020-7074
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number108270
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: