Provider Demographics
NPI:1629255831
Name:FRASURE, KATHY ANNETTE (RN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANNETTE
Last Name:FRASURE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:645 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2353
Mailing Address - Country:US
Mailing Address - Phone:812-339-1691
Mailing Address - Fax:812-337-2438
Practice Address - Street 1:645 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2353
Practice Address - Country:US
Practice Address - Phone:812-339-1691
Practice Address - Fax:812-337-2438
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2014-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28125376A163W00000X
IN71002676A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse