MEDICARE: BILLIE JO V 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	363A00000X	Physician Assistant		KY
2	363AM0700X	Medical Physician Assistant	PA1171	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000001081065	OTHER		ANTHEM PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9850334	OTHER		AETNA PIN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0827753	OTHER		CIGNA
6	1530621	OTHER	KY	WELLCARE OF KY PROVIDER ID
7	80515KYIP	OTHER	KY	AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
8	CS1728400147	OTHER		CARESOURCE ID

General Provider Information

NPI Number	:	1982757365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLIE JO V FLETCHER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 21890
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4115
Country	:	US
Telephone Number	:	502-907-0356
Fax Number	:	502-919-9780

Provider Business Practice Location Address
First Line	:	120 EXECUTIVE PARK
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4201
Country	:	US
Telephone Number	:	502-855-7200
Fax Number	:	502-855-7201

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	06/09/2022

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Directions to “ BILLIE JO V FLETCHER PA-C” Practice Location

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