Provider Demographics
NPI:1487650784
Name:FLETCHER, BOBBIE KATHERINE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:BOBBIE
Middle Name:KATHERINE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 ALDER AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1401
Mailing Address - Country:US
Mailing Address - Phone:253-891-0811
Mailing Address - Fax:253-891-4049
Practice Address - Street 1:920 ALDER AVE
Practice Address - Street 2:STE 203
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1401
Practice Address - Country:US
Practice Address - Phone:253-891-0811
Practice Address - Fax:253-891-4049
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003010363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9632035Medicaid
AB14397Medicare ID - Type Unspecified
WA9632035Medicaid