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NPI Code Detail

MEDICARE: JENNIFER LYNN FRARY PA-C

MEDICARE: JENNIFER LYNN FRARY 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
1363A00000XPhysician Assistant91WY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1315274OTHERWYBC/BS

General Provider Information

NPI Number : 1609862580
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNN FRARY PA-C
Provider Business Mailing Address
First Line : 6500 E 2ND ST
Second Line : SUITE 200
City : CASPER
State : WY
Zip : 82609-4338
Country : US
Telephone Number : 307-577-5100
Fax Number : 307-234-1201
Provider Business Practice Location Address
First Line : 6500 E 2ND ST
Second Line : SUITE 200
City : CASPER
State : WY
Zip : 82609-4338
Country : US
Telephone Number : 307-577-5100
Fax Number : 307-234-1201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 01/25/2008

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Directions to “ JENNIFER LYNN FRARY PA-C” Practice Location

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