Provider Demographics
NPI:1437305786
Name:RUSSO, FRANK LOUIS III (FNP)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:LOUIS
Last Name:RUSSO
Suffix:III
Gender:M
Credentials:FNP
Other - Prefix:MR
Other - First Name:FRANK
Other - Middle Name:L
Other - Last Name:RUSSO
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1601
Mailing Address - Country:US
Mailing Address - Phone:828-285-0622
Mailing Address - Fax:828-348-2025
Practice Address - Street 1:257 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4120
Practice Address - Country:US
Practice Address - Phone:828-285-0622
Practice Address - Fax:828-348-2025
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331109363LF0000X
NC5004156363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004332Medicaid
NC7004332Medicaid