Provider Demographics
NPI:1467961623
Name:FRAZIER, JEANINE NICOLE (ARNP)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:NICOLE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:NICOLE
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1520
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31310-8520
Mailing Address - Country:US
Mailing Address - Phone:912-877-2227
Mailing Address - Fax:912-877-2332
Practice Address - Street 1:303 FRASER DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3712
Practice Address - Country:US
Practice Address - Phone:912-877-2227
Practice Address - Fax:912-877-2332
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN151066363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$OtherSOCIAL SECURITY