Provider Demographics
NPI:1194338806
Name:FRICKE, SCOTT M (APN-NP)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:M
Last Name:FRICKE
Suffix:
Gender:M
Credentials:APN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 F ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2160
Mailing Address - Country:US
Mailing Address - Phone:719-204-4202
Mailing Address - Fax:877-483-3146
Practice Address - Street 1:134 F ST STE 209
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2160
Practice Address - Country:US
Practice Address - Phone:719-204-4202
Practice Address - Fax:877-483-3146
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996459363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health