Provider Demographics
NPI:1356461313
Name:FRY, JANET (NP)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 OLETA AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-2526
Mailing Address - Country:US
Mailing Address - Phone:936-634-3741
Mailing Address - Fax:
Practice Address - Street 1:202 S JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3112
Practice Address - Country:US
Practice Address - Phone:936-639-1005
Practice Address - Fax:936-631-3483
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX542235363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health