Provider Demographics
NPI:1598379927
Name:FRYE, PAIGE M
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:M
Last Name:FRYE
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 1:347606 E 800 RD
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-5382
Mailing Address - Country:US
Mailing Address - Phone:806-790-4199
Mailing Address - Fax:
Practice Address - Street 1:347606 E 800 RD
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-5382
Practice Address - Country:US
Practice Address - Phone:806-790-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKK083856455Medicaid