Provider Demographics
NPI:1073164554
Name:FRYE, MERISSA JOHNSON (APRN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MERISSA
Middle Name:JOHNSON
Last Name:FRYE
Suffix:
Gender:F
Credentials:APRN, MSN, FNP-BC
Other - Prefix:
Other - First Name:MERISSA
Other - Middle Name:JOHNSON
Other - Last Name:FRYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MERISSA JOHNSON
Mailing Address - Street 1:1275 DICK LONAS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1382
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:
Practice Address - Street 1:10820 KINGSTON PIKE STE 11
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3065
Practice Address - Country:US
Practice Address - Phone:865-671-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN26486OtherSTATE LICENSE