Provider Demographics
NPI:1982213617
Name:FRYDENDALL, JODI MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:MARIE
Last Name:FRYDENDALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:MARIE
Other - Last Name:TICHENOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:409 SHELTON DR
Mailing Address - Street 2:
Mailing Address - City:SMITH CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66967-3301
Mailing Address - Country:US
Mailing Address - Phone:785-282-5467
Mailing Address - Fax:
Practice Address - Street 1:715 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4451
Practice Address - Country:US
Practice Address - Phone:402-463-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-81263-042363LF0000X
NE114389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty