Provider Demographics
NPI:1699789305
Name:FRAZIER, ELIZABETH R (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:TN
Mailing Address - Zip Code:38257-2835
Mailing Address - Country:US
Mailing Address - Phone:731-479-2606
Mailing Address - Fax:731-479-2610
Practice Address - Street 1:1135 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:TN
Practice Address - Zip Code:38257-2835
Practice Address - Country:US
Practice Address - Phone:731-479-2606
Practice Address - Fax:731-479-2610
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2205P363L00000X
TN6339363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531866Medicaid
KY78008224Medicaid
TN103I500412OtherMEDICARE B-TN
KY295172OtherBCBS
TN4060375OtherBCBS TN
TN1531866Medicaid
KY0962204Medicare PIN