1124158126 NPI number — KAREN LYLE ROBERTS FRY MSN, CRNP

Table of content: KAREN LYLE ROBERTS FRY MSN, CRNP (NPI 1124158126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124158126 NPI number — KAREN LYLE ROBERTS FRY MSN, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS FRY
Provider First Name:
KAREN
Provider Middle Name:
LYLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124158126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1022 1ST ST N
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
ALABASTER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35007-8706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-621-7918
Provider Business Mailing Address Fax Number:
205-620-2503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 1ST STREET N
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ALABASTER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-621-7915
Provider Business Practice Location Address Fax Number:
205-620-2503
Provider Enumeration Date:
03/07/2007

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: 363LX0001X , with the licence number:  1084486 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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