Healthcare Provider Details

I. General information

NPI: 1164411831
Provider Name (Legal Business Name): CHARLENE MARGARET FRAZIER APN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HEDRICK DR
NEWPORT TN
37821-2902
US

IV. Provider business mailing address

6350 W A J HWY DEPARTMENT 100
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 423-623-5301
  • Fax: 423-625-0808
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAPN12030
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1115462
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN12030
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: