Provider Demographics
NPI:1760045405
Name:FLETCHER, JAMES LEE KYENSON (BM BCH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE KYENSON
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:BM BCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 PRIOR HALL, 376 W. 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:617-487-9503
Mailing Address - Fax:
Practice Address - Street 1:774 PRIOR HALL, 376 W. 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:617-487-9503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program