Provider Demographics
NPI:1679853550
Name:FLETCHER, EMILY R (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 ERWIN RD
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-1843
Mailing Address - Country:US
Mailing Address - Phone:919-681-0196
Mailing Address - Fax:919-681-8521
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:SUITE 2600
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-1807
Practice Address - Country:US
Practice Address - Phone:919-681-0196
Practice Address - Fax:919-681-8521
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-04312363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400059077Medicare PIN