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General NPI Number Information
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NPI Number | 1295080364
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Entity Type | Individual
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Provider Name | RACHEL LYNN FREDERICK PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 2610 NORTHRIDGE PKWY STE 103
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City | AMES
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State | IA
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Zip | 50010-4088
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Country | US
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Telephone | 515-789-3530
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Fax |
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Provider Business Mailing Address
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Address Line | 642 XAVIER PL
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City | AMES
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State | IA
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Zip | 50014-2676
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Country | US
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Telephone | 515-686-9231
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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 | 002308
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License Number State | IA
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