Provider Demographics
NPI:1225668528
Name:FLETCHER, KATELYN AMANDA (PA)
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:AMANDA
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:AMANDA
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 S 8TH ST STE 480W
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2403
Mailing Address - Country:US
Mailing Address - Phone:270-761-5756
Mailing Address - Fax:270-752-7856
Practice Address - Street 1:300 S 8TH ST STE 284W
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2452
Practice Address - Country:US
Practice Address - Phone:270-761-5756
Practice Address - Fax:270-752-7856
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-25
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KYTC027363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program