Provider Demographics
NPI:1710454798
Name:FRY, KATIE MARIE (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:FRY
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9146 W 92ND PL
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3905
Mailing Address - Country:US
Mailing Address - Phone:785-317-1701
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS118959163W00000X
KS5378362121363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse