Healthcare Provider Details

I. General information

NPI: 1881835163
Provider Name (Legal Business Name): PATRICIA KAY FRAY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATTY PAYNE

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 112TH AVE NE
BELLEVUE WA
98004-3732
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-453-1039
  • Fax: 425-453-8955
Mailing address:
  • Phone: 425-453-1039
  • Fax: 425-453-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAP60071357
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60071357
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: