Provider Demographics
NPI:1639648975
Name:FRY, KARLY MARTIN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KARLY
Middle Name:MARTIN
Last Name:FRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MARLBORO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-2639
Mailing Address - Country:US
Mailing Address - Phone:865-250-6700
Mailing Address - Fax:
Practice Address - Street 1:979 E 3RD ST STE C235
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3309
Practice Address - Country:US
Practice Address - Phone:423-602-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000187660163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine