Basic Information
| Provider Information | |||||||||
| NPI: | 1427453745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRAZIER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11055 SHOE CREEK DRIVE | ||||||||
| Address2: | |||||||||
| City: | CENTRAL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252614493 | ||||||||
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| Practice Location | |||||||||
| Address1: | 28315 S. FROST RD. | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252831356 | ||||||||
| FaxNumber: | 2256862962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2014 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP07842 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2517643 | 05 | LA | MEDICAID |