Provider Demographics
NPI:1174595722
Name:FLETCHER, LYNN (APRN)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HUXFORD ST
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-2356
Mailing Address - Country:US
Mailing Address - Phone:912-470-2273
Mailing Address - Fax:912-470-2630
Practice Address - Street 1:80 HUXFORD ST
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634
Practice Address - Country:US
Practice Address - Phone:912-470-2273
Practice Address - Fax:912-470-2630
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002502363LA2200X
GARN281395363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004224698Medicaid
CTP00057595OtherRAILROAD MEDICARE
CT500000912Medicare PIN
P71540Medicare UPIN