Provider Demographics
NPI:1427035245
Name:FLETCHER, SORAYA DINARI (NP)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:DINARI
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-5118
Mailing Address - Country:US
Mailing Address - Phone:940-464-2005
Mailing Address - Fax:
Practice Address - Street 1:1830 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4275
Practice Address - Country:US
Practice Address - Phone:970-945-8503
Practice Address - Fax:970-945-0253
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX638551363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health