1902969595 NPI number — KAREN E FRY LVN

Table of content: KAREN E FRY LVN (NPI 1902969595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902969595 NPI number — KAREN E FRY LVN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRY
Provider First Name:
KAREN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LVN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAMBERLAIN
Provider Other First Name:
KAREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LVN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902969595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
819 WATER ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
KERRVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78028-5333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-792-3300
Provider Business Mailing Address Fax Number:
830-792-5771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 CRYSTAL CITY HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UVALDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78801-6124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-278-1243
Provider Business Practice Location Address Fax Number:
830-278-1243
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164X00000X , with the licence number:  163894 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 163894 . This is a "LVN LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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