Basic Information
| Provider Information | |||||||||
| NPI: | 1922449917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRYE | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | MATLOCK | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 LOUISIANA AVE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711013910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182128951 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2551 GREENWOOD ROAD | ||||||||
| Address2: | SUITE #410 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186212929 | ||||||||
| FaxNumber: | 3186212930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2013 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP07374 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | AP07374 | 01 | LA | LSBN | OTHER |