Provider Demographics
NPI:1295791283
Name:FLETCHER, JANET MARY (PA C)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:MARY
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:PA C
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:918-786-9900
Mailing Address - Fax:918-786-9904
Practice Address - Street 1:900 E 13TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2976
Practice Address - Country:US
Practice Address - Phone:918-786-9900
Practice Address - Fax:918-786-9904
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2017-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1738363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200505990HMedicaid
OK200195710AMedicaid
OK200195710AMedicaid
OK900522214Medicare PIN
OK200505990HMedicaid
OKOK400509Medicare PIN