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General NPI Number Information
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NPI Number | 1649743956
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Entity Type | Organization
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Legal Business Name | KRYSTAL D FLETCHER APRN - CNP FAMILY PLLC
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 203 S MAIN ST
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City | LUTHER
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State | OK
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Zip | 73054-9385
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Country | US
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Telephone | 405-886-4186
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Fax | 405-445-7012
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Provider Business Mailing Address
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Address Line | PO BOX 785
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City | LUTHER
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State | OK
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Zip | 73054-0785
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Country | US
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Telephone | 405-886-4186
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Fax | 405-445-7012
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Authorized Official
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Title or Position | OWNER
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Name | KRYSTAL D FLETCHER
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Credential | APRN
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Telephone | 405-886-4186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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