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General NPI Number Information
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NPI Number | 1750625539
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Entity Type | Individual
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Provider Name | ALICIA D FRASURE FNP, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 604 N ROAN ST STE 101
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City | JOHNSON CITY
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State | TN
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Zip | 37601-4651
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Country | US
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Telephone | 423-900-3534
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Fax | 423-558-2525
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Provider Business Mailing Address
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Address Line | 1735 W STATE OF FRANKLIN RD STE 5 PB270
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City | JOHNSON CITY
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State | TN
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Zip | 37604
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Country | US
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Telephone | 423-900-3534
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Fax | 423-558-2525
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 17018
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License Number State | TN
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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 | 0024171150
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 17018
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License Number State | TN
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