Provider Demographics
NPI:1437697141
Name:FRY, VALTHEA COURTNEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:VALTHEA
Middle Name:COURTNEY
Last Name:FRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 TRIPLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3005
Mailing Address - Country:US
Mailing Address - Phone:301-926-8805
Mailing Address - Fax:
Practice Address - Street 1:9001 TRIPLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-3005
Practice Address - Country:US
Practice Address - Phone:301-926-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001272787163W00000X
VA0024175696363LF0000X
MARN2306818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse