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General NPI Number Information
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NPI Number | 1437697141
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Entity Type | Individual
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Provider Name | VALTHEA COURTNEY FRY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 9001 TRIPLE RIDGE RD
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-3005
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Country | US
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Telephone | 301-926-8805
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Fax |
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Provider Business Mailing Address
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Address Line | 9001 TRIPLE RIDGE RD
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-3005
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Country | US
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Telephone | 301-926-8805
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001272787
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024175696
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2306818
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License Number State | MA
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