Provider Demographics
NPI:1740476357
Name:FRYE, ERICA R (PA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:R
Last Name:FRYE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:R
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:97 GREAT TEAYS BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9815
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-757-3252
Practice Address - Street 1:12 KANAWHA TER
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2750
Practice Address - Country:US
Practice Address - Phone:304-201-1130
Practice Address - Fax:304-201-1134
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1072225OtherWV DWC
WV001991227OtherBLUE CROSS BLUE SHIELD
WVWV0089COtherMEDICARE PIN
WVWV0089BMedicare PIN
WVWV0089CMedicare PIN
WV29511Medicare PIN
WV001991227OtherBLUE CROSS BLUE SHIELD
WVQ417580001Medicare PIN