Provider Demographics
NPI:1316226426
Name:FREY, MARY BETH (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:FREY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:770 JASONWAY AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4333
Practice Address - Country:US
Practice Address - Phone:614-788-2730
Practice Address - Fax:614-538-8325
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP12474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055461Medicaid
OH0055461Medicaid