Provider Demographics
NPI:1518031657
Name:FRAZIER, ANNIE LAURA (PAC)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:LAURA
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:ANNIE
Other - Middle Name:LAURA
Other - Last Name:COURTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 ROSE STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536
Mailing Address - Country:US
Mailing Address - Phone:859-323-6265
Mailing Address - Fax:859-257-5303
Practice Address - Street 1:800 ROSE STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-323-6265
Practice Address - Fax:859-257-5303
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00489363A00000X
KYPA1984363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant