MEDICARE: REBECCA A FRY RN

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	163W00000X	Registered Nurse	789553	TX

General Provider Information

NPI Number	:	1750860169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA A FRY RN

Provider Business Mailing Address
First Line	:	3840 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-569-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	5765 WESTCREEK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3337
Country	:	US
Telephone Number	:	817-335-3022
Fax Number	:

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

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	08/08/2018

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Directions to “ REBECCA A FRY RN” Practice Location

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