Provider Demographics
NPI:1942859806
Name:FRAZIER, KISHIA MARIE
Entity Type:Individual
Prefix:
First Name:KISHIA
Middle Name:MARIE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:FLORAL
Mailing Address - State:AR
Mailing Address - Zip Code:72534-9788
Mailing Address - Country:US
Mailing Address - Phone:501-253-8822
Mailing Address - Fax:
Practice Address - Street 1:1559 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:FLORAL
Practice Address - State:AR
Practice Address - Zip Code:72534-9788
Practice Address - Country:US
Practice Address - Phone:501-253-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer