Basic Information
| Provider Information | |||||||||
| NPI: | 1821470642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRAZER-HALL | ||||||||
| FirstName: | AUDREY | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 CROSSINGS CIR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MOUNT JULIET | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371228592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157581010 | ||||||||
| FaxNumber: | 6157583875 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 CROSSINGS CIR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MOUNT JULIET | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371228592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157581010 | ||||||||
| FaxNumber: | 6157583875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2015 | ||||||||
| LastUpdateDate: | 02/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2750 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.