Healthcare Provider Details

I. General information

NPI: 1578956223
Provider Name (Legal Business Name): EMILY ANN FRY A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 AUTUMN RD SUITE 200
LITTLE ROCK AR
72211-3702
US

IV. Provider business mailing address

904 AUTUMN RD SUITE 200
LITTLE ROCK AR
72211-3702
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-6363
  • Fax:
Mailing address:
  • Phone: 501-227-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004291
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: