Provider Demographics
NPI:1356220487
Name:FREDERICK, SIERRA LYNN (RN)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:LYNN
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SABINA ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4974
Mailing Address - Country:US
Mailing Address - Phone:304-694-2820
Mailing Address - Fax:
Practice Address - Street 1:30 MON GENERAL DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2853
Practice Address - Country:US
Practice Address - Phone:304-598-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV120643163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse