Provider Demographics
NPI:1770035222
Name:FRJELICH, KRISTIN ALICIA SCOLARICI
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ALICIA SCOLARICI
Last Name:FRJELICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ALICIA
Other - Last Name:SCOLARICI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 LYLE CURTIS CIR
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2519
Mailing Address - Country:US
Mailing Address - Phone:618-550-9892
Mailing Address - Fax:
Practice Address - Street 1:150 LYLE CURTIS CIR
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2519
Practice Address - Country:US
Practice Address - Phone:618-550-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016035213363L00000X
IL209014986363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner