Provider Demographics
NPI:1669673638
Name:FRY, KRISTIE WALKER (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:WALKER
Last Name:FRY
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:MISS
Other - First Name:KRISTIE
Other - Middle Name:DEANNE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:445 N SILVERBELL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2686
Mailing Address - Country:US
Mailing Address - Phone:520-872-7238
Mailing Address - Fax:520-872-7638
Practice Address - Street 1:445 N SILVERBELL RD STE 202
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2686
Practice Address - Country:US
Practice Address - Phone:520-872-7238
Practice Address - Fax:520-872-7638
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13529363LA2100X
AZAP4519363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care