Provider Demographics
NPI:1629223433
Name:FLETCHER, HALLIE JEAN (LOT)
Entity Type:Individual
Prefix:MS
First Name:HALLIE
Middle Name:JEAN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 RAINS COUNTY ROAD 3130
Mailing Address - Street 2:
Mailing Address - City:EMORY
Mailing Address - State:TX
Mailing Address - Zip Code:75440
Mailing Address - Country:US
Mailing Address - Phone:903-474-9080
Mailing Address - Fax:925-892-0457
Practice Address - Street 1:320 RS COUNTY ROAD 3130
Practice Address - Street 2:
Practice Address - City:EMORY
Practice Address - State:TX
Practice Address - Zip Code:75440-4686
Practice Address - Country:US
Practice Address - Phone:903-474-9080
Practice Address - Fax:925-892-0457
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109548172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker