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General NPI Number Information
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NPI Number | 1184917866
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Entity Type | Individual
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Provider Name | ARIANNE M FREDRICKSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/27/2011
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1810 RICHMOND AVE
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City | PORT ROYAL
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State | SC
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Zip | 29935-2015
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Country | US
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Telephone | 843-781-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 254 RUDDER RUN
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City | BLUFFTON
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State | SC
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Zip | 29910-4306
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Country | US
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Telephone | 715-456-1480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3023
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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