Provider Demographics
NPI:1396254447
Name:FRYE, JACQUELINE HASTING (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:HASTING
Last Name:FRYE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ROSE
Other - Last Name:HASTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:102 TREASURE CV
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4479
Mailing Address - Country:US
Mailing Address - Phone:903-293-4763
Mailing Address - Fax:
Practice Address - Street 1:1025 CAMELLIA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6679
Practice Address - Country:US
Practice Address - Phone:337-347-8826
Practice Address - Fax:337-456-1202
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily