MEDICARE: DR. KASEY ANN FRYE FNP, DC

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	111N00000X	Chiropractor	5449	TX
2	363LF0000X	Family Nurse Practitioner	AP127028	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1609058908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KASEY ANN FRYE FNP, DC

Provider Business Mailing Address
First Line	:	17655 HENDERSON PASS
Second Line	:	816
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1502
Country	:	US
Telephone Number	:	956-763-7767
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 E QUINCY ST STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1922
Country	:	US
Telephone Number	:	210-229-7242
Fax Number	:

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

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	01/03/2017

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