Provider Demographics
NPI:1972919041
Name:MEYER-FLETCHER, CHERISA ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERISA
Middle Name:ANNE
Last Name:MEYER-FLETCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21317 MCCLELLAN CIR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-3962
Mailing Address - Country:US
Mailing Address - Phone:319-431-0244
Mailing Address - Fax:
Practice Address - Street 1:21317 MCCLELLAN CIR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-3962
Practice Address - Country:US
Practice Address - Phone:319-431-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074510363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical