Provider Demographics
NPI:1821470642
Name:FRAZER-HALL, AUDREY (PA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:FRAZER-HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CROSSINGS CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8592
Mailing Address - Country:US
Mailing Address - Phone:615-758-1010
Mailing Address - Fax:615-758-3875
Practice Address - Street 1:5000 CROSSINGS CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8592
Practice Address - Country:US
Practice Address - Phone:615-758-1010
Practice Address - Fax:615-758-3875
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant