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NPI Code Detail

MEDICARE: SAMEDRA FLETCHER

MEDICARE: SAMEDRA 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
1103K00000XBehavior AnalystLA

General Provider Information

NPI Number : 1518605633
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMEDRA FLETCHER
Provider Business Mailing Address
First Line : 7505 PINES RD STE 1160
Second Line :
City : SHREVEPORT
State : LA
Zip : 71129-3924
Country : US
Telephone Number : 318-703-4779
Fax Number : 318-918-1258
Provider Business Practice Location Address
First Line : 7505 PINES RD STE 1160
Second Line :
City : SHREVEPORT
State : LA
Zip : 71129-3924
Country : US
Telephone Number : 318-703-4779
Fax Number : 318-918-1258
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2022
Last Update Date : 05/27/2022

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Directions to “ SAMEDRA FLETCHER ” Practice Location

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