Individual provider Active NPI

Katrina Ann Fletcher, M.D.

  • Child & Adolescent Psychiatry Physician
  • Philadelphia, PA
National Provider Identifier
1831401496
Registry record updated May 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
MD452157 Issued in PA
Practice address
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone
(215) 590-7555
NPI assigned
Jul 11, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MT 196783 PA
Child & Adolescent Psychiatry Physician 2084P0804X MT 196783 PA
Child & Adolescent Psychiatry Physician 2084P0804X MD452157 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Philadelphia, PA 19104-4319

Mailing address

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-7555

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD452157PAMDChild & Adolescent Psychiatry Physician
MT 196783PAMDChild & Adolescent Psychiatry Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463961600000",
    "number": "1831401496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-590-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLETCHER",
        "first_name": "KATRINA",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-11",
        "last_updated": "2016-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MT 196783",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "PA",
            "license": "MT 196783",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "PA",
            "license": "MD452157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.