Provider Demographics
NPI:1114965050
Name:FRASE, PRISCILLA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANNE
Last Name:FRASE
Suffix:
Gender:F
Credentials:MD
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 1100
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1100
Mailing Address - Country:US
Mailing Address - Phone:417-256-9111
Mailing Address - Fax:417-257-5999
Practice Address - Street 1:1100 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2029
Practice Address - Country:US
Practice Address - Phone:417-257-5800
Practice Address - Fax:417-257-5999
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39816208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00242684OtherRAILROAD MEDICARE
TN4152346OtherBLUECROSS
TN4108303OtherBLUECROSS
TN3333422Medicaid
MO1114965050Medicaid
I38229Medicare UPIN
MO1114965050Medicaid
TN3333423Medicare PIN