Provider Demographics
NPI:1558995738
Name:FRAZIER, PATRICIA HOLLEY
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:HOLLEY
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E LOOP 304 STE 50
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-3419
Mailing Address - Country:US
Mailing Address - Phone:936-544-7223
Mailing Address - Fax:936-544-8083
Practice Address - Street 1:1501 E LOOP 304 STE 50
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-3419
Practice Address - Country:US
Practice Address - Phone:936-544-7223
Practice Address - Fax:936-544-8083
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12345Medicaid