Provider Demographics
NPI:1275322174
Name:FRAZIER, KRISTEN LEE
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEE
Last Name:FRAZIER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 DALE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5212
Mailing Address - Country:US
Mailing Address - Phone:423-765-3868
Mailing Address - Fax:
Practice Address - Street 1:858 DALE ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5212
Practice Address - Country:US
Practice Address - Phone:423-765-3868
Practice Address - Fax:423-765-3868
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN118176910172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver