MEDICARE: MS. LINDA GRACE FREY MSN, FNP-BC, RNFA

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	146414	MO
2	163WR0006X	Registered Nurse First Assistant	14-97759-112	KS
3	363LF0000X	Family Nurse Practitioner	46307	KS

General Provider Information

NPI Number	:	1639109440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA GRACE FREY MSN, FNP-BC, RNFA

Provider Business Mailing Address
First Line	:	18100 E 215TH ST
Second Line	:
City	:	PECULIAR
State	:	MO
Zip	:	64078-9200
Country	:	US
Telephone Number	:	816-304-7107
Fax Number	:	816-380-6529

Provider Business Practice Location Address
First Line	:	18100 E 215TH ST
Second Line	:
City	:	PECULIAR
State	:	MO
Zip	:	64078-9200
Country	:	US
Telephone Number	:	816-304-7107
Fax Number	:	816-380-6529

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	02/16/2009

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