Provider Demographics
NPI:1386996890
Name:FRAILEY, AMBER (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:FRAILEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2467
Mailing Address - Street 2:
Mailing Address - City:ROSICLARE
Mailing Address - State:IL
Mailing Address - Zip Code:62982-2467
Mailing Address - Country:US
Mailing Address - Phone:618-285-2800
Mailing Address - Fax:
Practice Address - Street 1:1 FERRELL ROAD
Practice Address - Street 2:
Practice Address - City:ROSICLARE
Practice Address - State:IL
Practice Address - Zip Code:62982-2467
Practice Address - Country:US
Practice Address - Phone:618-285-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012034636363LF0000X
IL209.009977363LF0000X
KY3007781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily