Provider Demographics
NPI:1497334668
Name:FRY, ALLYSON MEGAN (NP-C)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MEGAN
Last Name:FRY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:MEGAN
Other - Last Name:GOODPASTURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:18820 STATE HIGHWAY 305 NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6234
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:18820 STATE HIGHWAY 305 NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6234
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61160415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily