Provider Demographics
NPI:1659367860
Name:FLETCHER, JEAN CARSON (ARNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:CARSON
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 OWL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORKS
Mailing Address - State:WA
Mailing Address - Zip Code:98331-9474
Mailing Address - Country:US
Mailing Address - Phone:360-374-5627
Mailing Address - Fax:
Practice Address - Street 1:140 C ST
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9024
Practice Address - Country:US
Practice Address - Phone:360-374-3514
Practice Address - Fax:360-374-5464
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000151363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health