Provider Demographics
NPI:1033729454
Name:FLETCHER, MICHELLE (NP-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 HUALAPAI MOUNTAIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-8374
Mailing Address - Country:US
Mailing Address - Phone:928-681-8530
Mailing Address - Fax:928-681-8714
Practice Address - Street 1:2226 HUALAPAI MOUNTAIN RD STE 100
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-8374
Practice Address - Country:US
Practice Address - Phone:928-681-8530
Practice Address - Fax:928-681-8714
Is Sole Proprietor?:No
Enumeration Date:2020-08-01
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ245664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily