Provider Demographics
NPI:1003486176
Name:FRIDELL, FRANCES CAROLINE
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:CAROLINE
Last Name:FRIDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-4699
Mailing Address - Country:US
Mailing Address - Phone:870-836-1000
Mailing Address - Fax:870-836-1065
Practice Address - Street 1:638 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4699
Practice Address - Country:US
Practice Address - Phone:870-836-1000
Practice Address - Fax:870-836-1065
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1587133V00000X
MAALLP-328340174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN