Provider Demographics
NPI:1699050161
Name:FRAZIER-RICE, TARA LEE (FNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LEE
Last Name:FRAZIER-RICE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1602
Mailing Address - Country:US
Mailing Address - Phone:541-821-5304
Mailing Address - Fax:
Practice Address - Street 1:400 W HERSEY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1864
Practice Address - Country:US
Practice Address - Phone:541-482-7047
Practice Address - Fax:541-552-1009
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR097000451RN163W00000X
OR201391242NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse