Provider Demographics
NPI:1215736608
Name:FREDERICK, ALICIA BRITT
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:BRITT
Last Name:FREDERICK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ELM ST APT 4
Mailing Address - Street 2:
Mailing Address - City:JULESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80737-1680
Mailing Address - Country:US
Mailing Address - Phone:308-778-7542
Mailing Address - Fax:
Practice Address - Street 1:605 W 1ST ST
Practice Address - Street 2:
Practice Address - City:BIG SPRINGS
Practice Address - State:NE
Practice Address - Zip Code:69122-2268
Practice Address - Country:US
Practice Address - Phone:308-778-7542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care