Healthcare Provider Details

I. General information

NPI: 1659092617
Provider Name (Legal Business Name): NATHANIEL FRISCH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 POLIFKA DR
SHAW AFB SC
29152-5100
US

IV. Provider business mailing address

4301 WILSON ST
FORT SILL OK
73503-4472
US

V. Phone/Fax

Practice location:
  • Phone: 803-895-6356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: