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NPI Code Detail

MEDICARE: SAMANTHA M FRY APRN

MEDICARE: SAMANTHA M FRY APRN
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 Practitioner214515AR

General Provider Information

NPI Number : 1366600694
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA M FRY APRN
Provider Business Mailing Address
First Line : 5003 S 27 1/2 ST
Second Line :
City : PARAGOULD
State : AR
Zip : 72450-5297
Country : US
Telephone Number : 870-897-5831
Fax Number :
Provider Business Practice Location Address
First Line : 225 E WASHINGTON AVE
Second Line :
City : JONESBORO
State : AR
Zip : 72401-3111
Country : US
Telephone Number : 870-207-4388
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2008
Last Update Date : 08/30/2021

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Directions to “ SAMANTHA M FRY APRN” Practice Location

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