1982757365 NPI number — BILLIE JO V FLETCHER PA-C

Table of content: BILLIE JO V FLETCHER PA-C (NPI 1982757365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982757365 NPI number — BILLIE JO V FLETCHER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLETCHER
Provider First Name:
BILLIE JO
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982757365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-907-0356
Provider Business Mailing Address Fax Number:
502-919-9780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 EXECUTIVE PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-855-7200
Provider Business Practice Location Address Fax Number:
502-855-7201
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA1171 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000001081065 . This is a "ANTHEM PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300009700 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9850334 . This is a "AETNA PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100071530 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0827753 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1530621 . This is a "WELLCARE OF KY PROVIDER ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 80515KYIP . This is a "AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CS1728400147 . This is a "CARESOURCE ID" identifier . This identifiers is of the category "OTHER".




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