Healthcare Provider Details

I. General information

NPI: 1922978220
Provider Name (Legal Business Name): BENJAMIN LEE FLETCHER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 CASS RD
SLATYFORK WV
26291-9014
US

IV. Provider business mailing address

431 CASS RD
SLATYFORK WV
26291-9014
US

V. Phone/Fax

Practice location:
  • Phone: 304-473-5600
  • Fax:
Mailing address:
  • Phone: 304-473-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number124221
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: