Provider Demographics
NPI:1720070048
Name:FLETCHER, WYNETTA J (APRN)
Entity type:Individual
Prefix:
First Name:WYNETTA
Middle Name:J
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, APRN
Mailing Address - Street 1:214 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1620
Mailing Address - Country:US
Mailing Address - Phone:606-784-8682
Mailing Address - Fax:606-462-8123
Practice Address - Street 1:214 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1620
Practice Address - Country:US
Practice Address - Phone:606-784-8682
Practice Address - Fax:606-462-8123
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002992363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78003357Medicaid
KY3002992OtherKY BOARD OF NURSING