DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: FREDERIC W NORTHERN PA-C

MEDICARE: FREDERIC W NORTHERN PA-C
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
1363AM0700XMedical Physician AssistantPA2013-0085NM
2363A00000XPhysician AssistantPA2013-0085NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548682842
Entity Type Code : Individual
Provider Name (Legal Business Name) : FREDERIC W NORTHERN PA-C
Provider Business Mailing Address
First Line : 401 E SENECA AVE
Second Line :
City : MCALESTER
State : OK
Zip : 74501-6427
Country : US
Telephone Number : 918-916-6894
Fax Number :
Provider Business Practice Location Address
First Line : 707 PASEO DE PERALTA
Second Line :
City : SANTA FE
State : NM
Zip : 87501-1922
Country : US
Telephone Number : 505-989-8707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2014
Last Update Date : 07/30/2025

Similar Medicare Providers

1962568253 — TAOS COMPREHENSIVE HEALTH CORPORATION
Practice Location Address:
707 PASEO DE PERALTA
SANTA FE, NM
87501-1922
Practice Phone: 505-577-4543
Practice Fax: 505-989-3536
1629035142 — MR. JOHN ROBERT VANDERHEE PA-C, MPAS
Practice Location Address:
707 PASEO DE PERALTA
SANTA FE, NM
87501-1922
Practice Phone: 505-989-8707
Practice Fax:
1184731770 — MS. JULIA CHRISTINE DAVIS PA.
Practice Location Address:
707 PASEO DE PERALTA
SANTA FE, NM
87501-1922
Practice Phone: 505-989-8707
Practice Fax:
1962645283 — CAROL ANN CHAPPELL PA-C
Practice Location Address:
707 PASEO DE PERALTA
SANTA FE, NM
87501-1922
Practice Phone: 505-989-8707
Practice Fax: 505-989-3536
1700291648 — SAVANNAH TANNER PA-C
Practice Location Address:
707 PASEO DE PERALTA
SANTA FE, NM
87501-1922
Practice Phone: 505-989-8707
Practice Fax: 505-989-3536
1629938873 — MARYLOU BACA
Practice Location Address:
707 PASEO DE PERALTA
SANTA FE, NM
87501-1922
Practice Phone: 505-989-8707
Practice Fax: 505-989-3536

Directions to “ FREDERIC W NORTHERN PA-C” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.