Healthcare Provider Details

I. General information

NPI: 1942271093
Provider Name (Legal Business Name): VICKI R FRYE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1494 STUART RD NE
CLEVELAND TN
37312-5823
US

IV. Provider business mailing address

7100 COMMERCE WAY SUITE 180
BRENTWOOD TN
37027-2829
US

V. Phone/Fax

Practice location:
  • Phone: 423-614-0777
  • Fax: 423-614-0888
Mailing address:
  • Phone: 615-465-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0703
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: