Provider Demographics
NPI:1588750392
Name:FRAZIER, CAROL (CRNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 E 11TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4770
Mailing Address - Country:US
Mailing Address - Phone:256-237-5302
Mailing Address - Fax:256-237-5368
Practice Address - Street 1:522 E 11TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4770
Practice Address - Country:US
Practice Address - Phone:256-237-5302
Practice Address - Fax:256-237-5368
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1032839363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891003190Medicaid
AL891003190Medicaid
AL51030888Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER