Provider Demographics
NPI:1194451971
Name:FRAZIER, SAMUEL (APRN, CNS)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:
Credentials:APRN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 CARLOW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4346
Mailing Address - Country:US
Mailing Address - Phone:512-507-6664
Mailing Address - Fax:
Practice Address - Street 1:24900 SE STARK ST STE 109
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3381
Practice Address - Country:US
Practice Address - Phone:503-413-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087151364S00000X
OR10037912364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist