MEDICARE: ANGELA M FRIERSON PROSTHETIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1164196119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA M FRIERSON PROSTHETIST

Provider Business Mailing Address
First Line	:	PO BOX 17025
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-0025
Country	:	US
Telephone Number	:	501-200-4565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 BITTERCRESS DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-9779
Country	:	US
Telephone Number	:	501-246-9310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	07/13/2022

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