Healthcare Provider Details

I. General information

NPI: 1033640776
Provider Name (Legal Business Name): SIMPLY FRAZIER BEAUTY SALON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 JEFFREYS RD
ROCKY MOUNT NC
27804
US

IV. Provider business mailing address

1141 JEFFREYS RD
ROCKY MOUNT NC
27804
US

V. Phone/Fax

Practice location:
  • Phone: 252-443-3337
  • Fax: 252-443-3337
Mailing address:
  • Phone: 252-443-3337
  • Fax: 252-443-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA RICHARDSON
Title or Position: OWNER/OPERATOR
Credential: COSMETOLOGY/HAIR LOS
Phone: 252-904-9845