Provider Demographics
NPI:1487520326
Name:FRYER, MCKISA PATRICIA (MSN)
Entity type:Individual
Prefix:MRS
First Name:MCKISA
Middle Name:PATRICIA
Last Name:FRYER
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7012 IRWELL LN # 14E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-4893
Mailing Address - Country:US
Mailing Address - Phone:571-277-2892
Mailing Address - Fax:
Practice Address - Street 1:7012 IRWELL LN # 14E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-4893
Practice Address - Country:US
Practice Address - Phone:571-277-2892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189702363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health