Provider Demographics
NPI:1336186659
Name:FLETCHER, PAMELA K (CNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5505
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:68 CAVALIER BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1645
Practice Address - Country:US
Practice Address - Phone:513-475-7630
Practice Address - Fax:859-781-8374
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.07133-NP363L00000X
KY1094815363L00000X
OHCOA07133NP363LF0000X
KY3003296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013836Medicaid
OHPOO188110OtherMEDICARE /RR /PIN
OH2526716Medicaid
P29968Medicare UPIN
OH2526716Medicaid
OHFLNP15961Medicare PIN
OHPOO188110OtherMEDICARE /RR /PIN
KY78013836Medicaid
OHFLNP15962Medicare PIN