Cody Joseph Fletcher, ATC, LAT

Individual provider Active NPI Athletic Trainer · Henderson, TN

NPI 1407473085 · NPPES record last updated Jun 30, 2020

Key facts

NPI
1407473085
Entity type
Individual (NPI type 1)
Primary specialty
Athletic Trainer 2255A2300X
License
0000001835 (TN)
Practice address
158 E Main St
Henderson, TN 38340-2306
Phone
(573) 999-3792
NPI assigned
Jun 30, 2020
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
0000001835TNMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Freed-Hardeman University Past
since Jul 5, 2020
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 0000001835 TN Yes

Addresses

Primary practice location

158 E Main St
Henderson, TN 38340-2306

Mailing address

80 Timber Ridge CV
Henderson, TN 38340-4451
Phone (573) 999-3792

Other providers in Henderson, TN

All providers in Henderson, TN · Athletic Trainer in Tennessee

Sources for this page

Verify at the official NPI Registry.