Provider Demographics
NPI:1073634028
Name:FRYE, DESIREE (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2213
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:425 N HIGHLAND AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7377
Practice Address - Country:US
Practice Address - Phone:903-892-9179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX642522363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX642522OtherNURSE PRACTITIONER LICENSE