Provider Demographics
NPI:1972088920
Name:FRICK, JAMIE LYNN (NP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:FRICK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W OLD COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:AL
Mailing Address - Zip Code:35616-4212
Mailing Address - Country:US
Mailing Address - Phone:256-762-4749
Mailing Address - Fax:
Practice Address - Street 1:620 W OLD COVERED BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:AL
Practice Address - Zip Code:35616-4212
Practice Address - Country:US
Practice Address - Phone:256-762-4749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-159359163W00000X
MS906169163W00000X
MS902920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse