Healthcare Provider Details

I. General information

NPI: 1639161367
Provider Name (Legal Business Name): KATHRYN A. FLETCHER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 BUCKEYSTOWN PIKE
FREDERICK MD
21703-8331
US

IV. Provider business mailing address

PO BOX 277045
ATLANTA GA
30384-7045
US

V. Phone/Fax

Practice location:
  • Phone: 240-379-6045
  • Fax: 240-379-6050
Mailing address:
  • Phone: 240-379-6045
  • Fax: 240-379-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: