Provider Demographics
NPI:1831104710
Name:FRYE, KIMBERLY CHRISTINE (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CHRISTINE
Last Name:FRYE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:CHILDRENS SURGICAL SPECIALTY GROUP INC
Mailing Address - Street 2:PO BOX 631617
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1617
Mailing Address - Country:US
Mailing Address - Phone:757-668-6550
Mailing Address - Fax:757-893-6024
Practice Address - Street 1:171 KEMPSVILLE RD
Practice Address - Street 2:#201
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4700
Practice Address - Country:US
Practice Address - Phone:757-668-6550
Practice Address - Fax:757-893-6024
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006406971Medicaid
VA35573POtherOPTIMA/SENTARA HEALTH
VAP22409Medicare UPIN
VA006406971Medicaid