Provider Demographics
NPI:1437869526
Name:PEAVY, FLETCHER (PA-C)
Entity Type:Individual
Prefix:
First Name:FLETCHER
Middle Name:
Last Name:PEAVY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 LAS PALMAS ENTRADA AVE APT 1927
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5628
Mailing Address - Country:US
Mailing Address - Phone:480-434-4065
Mailing Address - Fax:
Practice Address - Street 1:5440 W SAHARA AVE STE 302
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0361
Practice Address - Country:US
Practice Address - Phone:702-633-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2783363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical