Provider Demographics
NPI:1750625539
Name:FRASURE, ALICIA D (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:D
Last Name:FRASURE
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 W STATE OF FRANKLIN RD STE 5
Mailing Address - Street 2:PB270
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-900-3534
Mailing Address - Fax:423-558-2525
Practice Address - Street 1:604 N ROAN ST STE 101
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4651
Practice Address - Country:US
Practice Address - Phone:423-900-3534
Practice Address - Fax:423-558-2525
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17018363LF0000X, 363LP0808X
VA0024171150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530700Medicaid
VA0024171150OtherFNP
TNAPN17018OtherTN LICENSE
TNRN169173OtherTN LICENSE
TN103I500785Medicare PIN
TNAPN17018OtherTN LICENSE