Provider Demographics
NPI:1912616277
Name:FRYER, SYDNEY KAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:KAY
Last Name:FRYER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:KAY
Other - Last Name:EYBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1605 MARTIN SPRINGS DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3028
Mailing Address - Country:US
Mailing Address - Phone:573-458-6350
Mailing Address - Fax:
Practice Address - Street 1:1605 MARTIN SPRINGS DR STE 210
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3028
Practice Address - Country:US
Practice Address - Phone:573-458-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022038051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily