Provider Demographics
NPI:1285964551
Name:FRAZIER, DEJUANA NICOLE (APRN)
Entity type:Individual
Prefix:MS
First Name:DEJUANA
Middle Name:NICOLE
Last Name:FRAZIER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40210-2135
Mailing Address - Country:US
Mailing Address - Phone:502-523-6915
Mailing Address - Fax:
Practice Address - Street 1:2321 OREGON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40210-2135
Practice Address - Country:US
Practice Address - Phone:502-523-6915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100143080Medicaid