Provider Demographics
NPI:1245857762
Name:FRISSORA, KELLIE DENNISTON (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:DENNISTON
Last Name:FRISSORA
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Gender:F
Credentials:APRN, NP-C
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Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:888-973-8821
Practice Address - Street 1:200 S WACKER DR FL 31
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5877
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:888-973-8821
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2025-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ278421363LF0000X
IL209.021129363LF0000X
COAPN.0996971-NP363LF0000X
OR10023562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily