Provider Demographics
NPI:1609058908
Name:FRYE, KASEY ANN (FNP, DC)
Entity Type:Individual
Prefix:DR
First Name:KASEY
Middle Name:ANN
Last Name:FRYE
Suffix:
Gender:F
Credentials:FNP, DC
Other - Prefix:
Other - First Name:KAYCE
Other - Middle Name:ANN
Other - Last Name:FRYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP, DC
Mailing Address - Street 1:17655 HENDERSON PASS
Mailing Address - Street 2:816
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1502
Mailing Address - Country:US
Mailing Address - Phone:956-763-7767
Mailing Address - Fax:
Practice Address - Street 1:303 E QUINCY ST STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1922
Practice Address - Country:US
Practice Address - Phone:210-229-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5449111N00000X
TXAP127028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001819401Medicaid
TX001819401Medicaid
TXU0988Medicare UPIN
TX8C6656Medicare PIN