Healthcare Provider Details

I. General information

NPI: 1821472044
Provider Name (Legal Business Name): KATHRYN A FRY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12101 UNION SCHOOL RD
AUBURN IL
62615-9292
US

IV. Provider business mailing address

12101 UNION SCHOOL RD
AUBURN IL
62615-9292
US

V. Phone/Fax

Practice location:
  • Phone: 217-801-3015
  • Fax: 872-231-0577
Mailing address:
  • Phone: 217-801-3015
  • Fax: 872-231-0577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001424
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8837
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: