Provider Demographics
NPI:1093890345
Name:FRY, HELEN REGINA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:REGINA
Last Name:FRY
Suffix:
Gender:F
Credentials:CRNA
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 950195
Mailing Address - Street 2:DEPT. 86236
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0195
Mailing Address - Country:US
Mailing Address - Phone:502-473-2100
Mailing Address - Fax:502-459-6461
Practice Address - Street 1:1 AUDUBON PLAZA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1318
Practice Address - Country:US
Practice Address - Phone:502-636-7160
Practice Address - Fax:502-636-8760
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY607A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33272OtherCERTIFICATION
KY74332727Medicaid
KYS71025Medicare UPIN
KY93656Medicare ID - Type Unspecified
KY74332727Medicaid
KY0783084Medicare PIN
KY1093890345Medicare UPIN