MEDICARE: TRACY FRYE REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	846509	NV

General Provider Information

NPI Number	:	1164119483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY FRYE REGISTERED NURSE

Provider Business Mailing Address
First Line	:	6868 SKY POINTE DR UNIT 2010
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-6112
Country	:	US
Telephone Number	:	806-407-2117
Fax Number	:

Provider Business Practice Location Address
First Line	:	7975 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7942
Country	:	US
Telephone Number	:	806-407-2117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	06/17/2025

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Directions to “ TRACY FRYE REGISTERED NURSE” Practice Location

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