Healthcare Provider Details

I. General information

NPI: 1649820366
Provider Name (Legal Business Name): KATIE FRALICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2019
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 W MAIN ST
BERNE IN
46711-1796
US

IV. Provider business mailing address

PO BOX 151
DECATUR IN
46733-0151
US

V. Phone/Fax

Practice location:
  • Phone: 260-724-2145
  • Fax:
Mailing address:
  • Phone: 260-724-2145
  • Fax: 260-728-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002847A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: