Provider Demographics
NPI:1477717015
Name:FRAZIER, KATHLEEN STEPHENS (NP-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:STEPHENS
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:STEPHENS
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:639 HEMLOCK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6886
Mailing Address - Country:US
Mailing Address - Phone:478-755-1560
Mailing Address - Fax:478-755-1562
Practice Address - Street 1:639 HEMLOCK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6886
Practice Address - Country:US
Practice Address - Phone:478-755-1560
Practice Address - Fax:478-755-1562
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149395363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner