Healthcare Provider Details

I. General information

NPI: 1912681800
Provider Name (Legal Business Name): ALLISON FRAICOLA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 STOCKTRAIL AVE
GILLETTE WY
82716-3582
US

IV. Provider business mailing address

508 STOCKTRAIL AVE
GILLETTE WY
82716-3582
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-1413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009382
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1348
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: