Provider Demographics
NPI:1205461621
Name:FRYKMAN, MARTIN KYLE (FNP-C)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:KYLE
Last Name:FRYKMAN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:MR
Other - First Name:MARTIN
Other - Middle Name:KYLE
Other - Last Name:FRYKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:401 MORNING GLORY LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2220
Mailing Address - Country:US
Mailing Address - Phone:214-918-8433
Mailing Address - Fax:
Practice Address - Street 1:3150 HORTON RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76119-5905
Practice Address - Country:US
Practice Address - Phone:817-413-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX724690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily