Healthcare Provider Details

I. General information

NPI: 1659367860
Provider Name (Legal Business Name): JEAN CARSON FLETCHER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 C ST
FORKS WA
98331-9024
US

IV. Provider business mailing address

1962 OWL CREEK RD
FORKS WA
98331-9474
US

V. Phone/Fax

Practice location:
  • Phone: 360-374-3514
  • Fax: 360-374-5464
Mailing address:
  • Phone: 360-374-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP30000151
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: