Healthcare Provider Details

I. General information

NPI: 1801754494
Provider Name (Legal Business Name): NIKKI MARIE FRYE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 S SOUTH ST
MOUNT AIRY NC
27030-5330
US

IV. Provider business mailing address

1016 S SOUTH ST
MOUNT AIRY NC
27030-5330
US

V. Phone/Fax

Practice location:
  • Phone: 336-783-8900
  • Fax:
Mailing address:
  • Phone: 336-783-8900
  • Fax: 336-783-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5024640
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001236222
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024197697
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: