Provider Demographics
NPI:1912486648
Name:FLETCHER, KENDRA LEANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:LEANN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:KENDRA
Other - Middle Name:LEANN
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:101 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3395
Mailing Address - Country:US
Mailing Address - Phone:479-968-2345
Mailing Address - Fax:
Practice Address - Street 1:101 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3363
Practice Address - Country:US
Practice Address - Phone:479-968-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005755363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics