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General NPI Number Information
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NPI Number | 1316903305
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Entity Type | Individual
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Provider Name | ROBERT LYLE FLETCHER PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2401 GILLHAM RD
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City | KANSAS CITY
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State | MO
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Zip | 64108-4619
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Country | US
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Telephone | 816-234-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 8809 FAIRWAY ST
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City | LEAWOOD
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State | KS
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Zip | 66206-1621
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Country | US
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Telephone | 913-642-3920
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2003022249
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License Number State | MO
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