Provider Demographics
NPI:1285652727
Name:FRYE, DIANNE T, (APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:T,
Last Name:FRYE
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:DIANNE T
Other - Last Name:FRYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-0337
Mailing Address - Country:US
Mailing Address - Phone:304-469-2905
Mailing Address - Fax:304-465-5486
Practice Address - Street 1:204 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:WV
Practice Address - Zip Code:25880-1129
Practice Address - Country:US
Practice Address - Phone:304-877-9133
Practice Address - Fax:304-877-2165
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV62597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7102315000Medicaid
WV7102315000Medicaid
WVWV1218CMedicare PIN
WVWV1218EMedicare PIN
WVWV1218BMedicare PIN