Healthcare Provider Details

I. General information

NPI: 1861214892
Provider Name (Legal Business Name): FAITH FRAZIER PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

304 N BEHREND AVE
FARMINGTON NM
87401-5843
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6228
  • Fax: 505-327-4887
Mailing address:
  • Phone: 505-325-1572
  • Fax: 505-327-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: