Healthcare Provider Details

I. General information

NPI: 1982335709
Provider Name (Legal Business Name): LAURA KATHLEEN FRAZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 STATE ROUTE 160
GALLIPOLIS OH
45631-8243
US

IV. Provider business mailing address

PO BOX 390
HUNTINGTON WV
25708-0390
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-4600
  • Fax: 740-446-2944
Mailing address:
  • Phone: 304-429-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0900645
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: