Provider Demographics
NPI:1497757348
Name:FRALEY, JAMES ROBERT (ARNP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:FRALEY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MONKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4436
Mailing Address - Country:US
Mailing Address - Phone:315-393-7637
Mailing Address - Fax:315-393-0927
Practice Address - Street 1:PSC 1003
Practice Address - Street 2:BOX 8
Practice Address - City:KEFLAVIK
Practice Address - State:ICELAND
Practice Address - Zip Code:AE
Practice Address - Country:IS
Practice Address - Phone:011354-425-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335121-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily