Provider Demographics
NPI:1699050286
Name:FLETCHER, KYLE THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:THOMAS
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 BEN ALI DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8937
Mailing Address - Country:US
Mailing Address - Phone:859-236-0903
Mailing Address - Fax:859-236-0903
Practice Address - Street 1:800 ROSE STREET C 236
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-257-5405
Practice Address - Fax:859-257-5096
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52252207Y00000X
KYR3482207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology