Basic Information
| Provider Information | |||||||||
| NPI: | 1588750392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRAZIER | ||||||||
| FirstName: | CAROL | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 522 E 11TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362074770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562375302 | ||||||||
| FaxNumber: | 2562375368 | ||||||||
| Practice Location | |||||||||
| Address1: | 522 E 11TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362074770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562375302 | ||||||||
| FaxNumber: | 2562375368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1032839 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 891003190 | 05 | AL | MEDICAID |