=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356461313
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET FRY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 S JOHN REDDITT DR
-----------------------------------------------------
City | LUFKIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75904-3112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-639-1005
-----------------------------------------------------
Fax | 936-631-3483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1012 OLETA AVE
-----------------------------------------------------
City | LUFKIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75901-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-634-3741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 542235
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------