Provider Demographics
NPI:1578877684
Name:FLETCHER, KENNETH D III (MSN,APRN,ANP-C)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:D
Last Name:FLETCHER
Suffix:III
Gender:M
Credentials:MSN,APRN,ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1106 RYAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5252
Mailing Address - Country:US
Mailing Address - Phone:337-497-9355
Mailing Address - Fax:337-437-3692
Practice Address - Street 1:1106 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5252
Practice Address - Country:US
Practice Address - Phone:337-497-9355
Practice Address - Fax:337-437-3692
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05451364SX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health