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NPI Code Detail

MEDICARE: STEPHANIE FRYE NP

MEDICARE: STEPHANIE FRYE NP
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
1363LF0000XFamily Nurse Practitioner71006689AIN
2363LF0000XFamily Nurse Practitioner28164765AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
128164765AOTHERINSTATE LICENSURE

General Provider Information

NPI Number : 1164979456
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE FRYE NP
Provider Business Mailing Address
First Line : 166 MAPLE RUN ESTATES BLVD
Second Line :
City : SPRINGVILLE
State : IN
Zip : 47462-5419
Country : US
Telephone Number : 812-583-4273
Fax Number :
Provider Business Practice Location Address
First Line : 2920 S MCINTIRE DR STE 350
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-4215
Country : US
Telephone Number : 812-353-3272
Fax Number : 812-353-3408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2016
Last Update Date : 02/25/2025

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