Provider Demographics
NPI:1164178976
Name:FRY, HAYLEY (PMHNP)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 E BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1015
Mailing Address - Country:US
Mailing Address - Phone:316-993-5942
Mailing Address - Fax:
Practice Address - Street 1:8650 E 32ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2635
Practice Address - Country:US
Practice Address - Phone:316-993-5942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80995-082363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSMF7121849OtherDEA-CONTROLLED SUBSTANCE REGISTRATION