MEDICARE: CHARLES HENRY FLETCHER PA-C

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	363AM0700X	Medical Physician Assistant	15-00518	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639151020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES HENRY FLETCHER PA-C

Provider Business Mailing Address
First Line	:	2600 N WOODLAWN BLVD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220-2729
Country	:	US
Telephone Number	:	316-684-3838
Fax Number	:	316-858-2530

Provider Business Practice Location Address
First Line	:	2600 N WOODLAWN BLVD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220-2729
Country	:	US
Telephone Number	:	316-684-3838
Fax Number	:	316-858-2521

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

Provider Enumeration Date	:	11/19/2005
Last Update Date	:	07/31/2014

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