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General NPI Number Information
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NPI Number | 1831776145
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Entity Type | Individual
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Provider Name | JACQUELYN FLETCHER RDH
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Gender | Female
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 530 S MAIN ST
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City | JOPLIN
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State | MO
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Zip | 64801-2314
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Country | US
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Telephone | 417-782-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 24200 INFINITY RD
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City | WEBB CITY
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State | MO
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Zip | 64870-8246
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Country | US
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Telephone | 417-529-8289
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2014016612
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License Number State | MO
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