Provider Demographics
NPI:1568211928
Name:FITT MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:FITT MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:409-291-0118
Mailing Address - Street 1:4407 KITTY CHAPIN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-9008
Mailing Address - Country:US
Mailing Address - Phone:409-291-0118
Mailing Address - Fax:
Practice Address - Street 1:575 18TH ST STE 4
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5031
Practice Address - Country:US
Practice Address - Phone:409-291-0118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty