MEDICARE: KELLIE MARIE FRIES FNP

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	363LF0000X	Family Nurse Practitioner	2018022898	MO

General Provider Information

NPI Number	:	1508341207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE MARIE FRIES FNP

Provider Business Mailing Address
First Line	:	1451 NW 38TH ST APT 110
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-4554
Country	:	US
Telephone Number	:	660-635-1392
Fax Number	:

Provider Business Practice Location Address
First Line	:	1914 SWIFT AVE
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3447
Country	:	US
Telephone Number	:	816-691-4156
Fax Number	:

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

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	09/27/2018

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