Provider Demographics
NPI:1902870595
Name:FRYE, PAMELLA (RNC-NP)
Entity Type:Individual
Prefix:
First Name:PAMELLA
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:RNC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-824-5806
Mailing Address - Fax:304-824-5885
Practice Address - Street 1:7400 LYNN AVE
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1138
Practice Address - Country:US
Practice Address - Phone:304-824-5806
Practice Address - Fax:304-824-5885
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV47388363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000139Medicaid
WV000670906OtherMS BCBS
WV080076470OtherRR MC
WV000670906OtherMS BCBS
WVWV2288BMedicare Oscar/Certification
WV080076470OtherRR MC
WV2033991Medicare Oscar/Certification