Healthcare Provider Details

I. General information

NPI: 1649713355
Provider Name (Legal Business Name): CURTIS FLETCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 W INTERSTATE 40 SUITE 120
AMARILLO TX
79106-2526
US

IV. Provider business mailing address

500 E 8TH AVE
DENVER CO
80203-3716
US

V. Phone/Fax

Practice location:
  • Phone: 806-576-3492
  • Fax:
Mailing address:
  • Phone: 303-253-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number04W792
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: