MEDICARE: VICKI R FRYE 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
1	207Q00000X	Family Medicine Physician	0703	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3164492	OTHER	TN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942271093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI R FRYE PA-C

Provider Business Mailing Address
First Line	:	7100 COMMERCE WAY
Second Line	:	SUITE 180
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2829
Country	:	US
Telephone Number	:	615-465-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1494 STUART RD NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-5823
Country	:	US
Telephone Number	:	423-614-0777
Fax Number	:	423-614-0888

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	08/13/2008

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Directions to “ VICKI R FRYE PA-C” Practice Location

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