Healthcare Provider Details

I. General information

NPI: 1093733677
Provider Name (Legal Business Name): JANICE KAY FRY RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST SUITE 4C201
LUBBOCK TX
79430-9410
US

IV. Provider business mailing address

PO BOX 5865
LUBBOCK TX
79408-5865
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-3150
  • Fax: 806-743-3148
Mailing address:
  • Phone: 806-743-2898
  • Fax: 806-743-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT00912
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: