Provider Demographics
NPI:1568066686
Name:FRAZIER, CORETTA (MBA-HRM)
Entity Type:Individual
Prefix:MRS
First Name:CORETTA
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MBA-HRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SUTTER DR
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-5034
Mailing Address - Country:US
Mailing Address - Phone:601-863-6997
Mailing Address - Fax:
Practice Address - Street 1:200 N CONGRESS ST STE 109
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-1902
Practice Address - Country:US
Practice Address - Phone:601-863-6997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS853667274OtherHOME HEALTH