Provider Demographics
NPI:1558174722
Name:FRY, ELYSSA MORGAN
Entity type:Individual
Prefix:
First Name:ELYSSA
Middle Name:MORGAN
Last Name:FRY
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 1:1268 TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-3530
Mailing Address - Country:US
Mailing Address - Phone:570-881-4135
Mailing Address - Fax:
Practice Address - Street 1:601 S HENDERSON RD STE 150601S
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3596
Practice Address - Country:US
Practice Address - Phone:570-881-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP032039363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health