Provider Demographics
NPI:1639109440
Name:FREY, LINDA GRACE (MSN, FNP-BC, RNFA)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:GRACE
Last Name:FREY
Suffix:
Gender:F
Credentials:MSN, FNP-BC, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18100 E 215TH ST
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-9200
Mailing Address - Country:US
Mailing Address - Phone:816-304-7107
Mailing Address - Fax:816-380-6529
Practice Address - Street 1:18100 E 215TH ST
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-9200
Practice Address - Country:US
Practice Address - Phone:816-304-7107
Practice Address - Fax:816-380-6529
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146414363LF0000X
KS14-97759-112163WR0006X
KS46307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant