Provider Demographics
NPI:1720729122
Name:FRY, MISTY ANN (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:ANN
Last Name:FRY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 COUNTY ROAD 225
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-0367
Mailing Address - Country:US
Mailing Address - Phone:325-217-2364
Mailing Address - Fax:
Practice Address - Street 1:2250 S FM 51 STE 400
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3767
Practice Address - Country:US
Practice Address - Phone:888-376-5274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily