Provider Demographics
NPI:1487680484
Name:FLETCHER, RICHARD (ARNP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:M
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:PO BOX 247
Mailing Address - Street 2:126 MAIN ST.
Mailing Address - City:PUTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05346-0247
Mailing Address - Country:US
Mailing Address - Phone:802-387-5581
Mailing Address - Fax:802-387-6694
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:
Practice Address - City:PUTNEY
Practice Address - State:VT
Practice Address - Zip Code:05346-8701
Practice Address - Country:US
Practice Address - Phone:802-387-5581
Practice Address - Fax:802-387-6694
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010017054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006076Medicaid
VT1006076Medicaid
VTNP0506Medicare ID - Type Unspecified