Provider Demographics
NPI:1184053563
Name:FRASIER, COREY DEAN (APRN)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:DEAN
Last Name:FRASIER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:105 STATE HIGHWAY 1947 # A
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-6825
Practice Address - Country:US
Practice Address - Phone:606-475-0152
Practice Address - Fax:606-474-4240
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020466363LF0000X
KY3008374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100425660Medicaid
OH0174020Medicaid