Provider Demographics
NPI:1083267553
Name:FREDERICK, AERIEL (APRN)
Entity Type:Individual
Prefix:
First Name:AERIEL
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:APRN
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 220
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-0220
Mailing Address - Country:US
Mailing Address - Phone:606-668-3120
Mailing Address - Fax:606-668-3125
Practice Address - Street 1:219 MOUNTAIN PARKWAY SPUR RD
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-8988
Practice Address - Country:US
Practice Address - Phone:606-668-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily