Provider Demographics
NPI:1407383276
Name:FLETCHER, CLARISA MECHELL
Entity Type:Individual
Prefix:
First Name:CLARISA
Middle Name:MECHELL
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 INDIAN TRL
Mailing Address - Street 2:APT B
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2297
Mailing Address - Country:US
Mailing Address - Phone:254-415-0025
Mailing Address - Fax:
Practice Address - Street 1:1507 INDIAN TRL
Practice Address - Street 2:APT B
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2297
Practice Address - Country:US
Practice Address - Phone:254-415-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health