MEDICARE: DIANNE T, FRYE APRN FNP-BC

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	363LF0000X	Family Nurse Practitioner	62597	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285652727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE T, FRYE APRN FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 337
Second Line	:
City	:	SCARBRO
State	:	WV
Zip	:	25917-0337
Country	:	US
Telephone Number	:	304-469-2905
Fax Number	:	304-465-5486

Provider Business Practice Location Address
First Line	:	204 S MOUNTAIN AVE
Second Line	:
City	:	MOUNT HOPE
State	:	WV
Zip	:	25880-1129
Country	:	US
Telephone Number	:	304-877-9133
Fax Number	:	304-877-2165

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/19/2015

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