Provider Demographics
NPI:1649743956
Name:KRYSTAL D FLETCHER APRN - CNP FAMILY PLLC
Entity Type:Organization
Organization Name:KRYSTAL D FLETCHER APRN - CNP FAMILY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-886-4186
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:LUTHER
Mailing Address - State:OK
Mailing Address - Zip Code:73054-0785
Mailing Address - Country:US
Mailing Address - Phone:405-886-4186
Mailing Address - Fax:405-445-7012
Practice Address - Street 1:203 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LUTHER
Practice Address - State:OK
Practice Address - Zip Code:73054-9385
Practice Address - Country:US
Practice Address - Phone:405-886-4186
Practice Address - Fax:405-445-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty