MEDICARE: MATTHEW CASH FLETCHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3015784	KY

General Provider Information

NPI Number	:	1255922498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW CASH FLETCHER

Provider Business Mailing Address
First Line	:	1860 JH OBRYAN AVE
Second Line	:
City	:	GRAND RIVERS
State	:	KY
Zip	:	42045-9049
Country	:	US
Telephone Number	:	270-362-8246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 JH OBRYAN AVE
Second Line	:
City	:	GRAND RIVERS
State	:	KY
Zip	:	42045-9049
Country	:	US
Telephone Number	:	270-362-8246
Fax Number	:	270-362-9757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2021
Last Update Date	:	12/02/2021

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