Provider Demographics
NPI:1063498707
Name:FRAZIER-GRIFFIN, VALERIE VICTORIA (CFNP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:VICTORIA
Last Name:FRAZIER-GRIFFIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 QUINCE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7254
Mailing Address - Country:US
Mailing Address - Phone:901-765-4898
Mailing Address - Fax:
Practice Address - Street 1:6116 QUINCE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-7254
Practice Address - Country:US
Practice Address - Phone:901-765-4898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR793654363L00000X
TN01599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0114773Medicaid
MS0114773Medicaid
MS500000641Medicare ID - Type UnspecifiedCFNP