Provider Demographics
NPI:1588672075
Name:FLETCHER, SARAH CRANDALL (C-FNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:CRANDALL
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MACCORKLE AVENUE SE
Mailing Address - Street 2:SUITE 509
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1226
Mailing Address - Country:US
Mailing Address - Phone:304-342-0821
Mailing Address - Fax:304-345-6679
Practice Address - Street 1:3100 MACCORKLE AVENUE SE
Practice Address - Street 2:SUITE 509
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1226
Practice Address - Country:US
Practice Address - Phone:304-342-0821
Practice Address - Fax:304-345-6679
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV49163363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0166600000Medicaid
P79571Medicare UPIN
WV0166600000Medicaid