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NPI Code Detail

MEDICARE: KENDALL FRYER

MEDICARE: KENDALL FRYER
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1225903453
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDALL FRYER
Provider Business Mailing Address
First Line : 225 OPAL AVE
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92662-1032
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 GOODYS LN
Second Line :
City : KNOXVILLE
State : TN
Zip : 37922-1914
Country : US
Telephone Number : 865-251-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2025
Last Update Date : 10/07/2025

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Directions to “ KENDALL FRYER ” Practice Location

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