Provider Demographics
NPI:1447492582
Name:FRALICK, IVY DUNCAN (APRN)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:DUNCAN
Last Name:FRALICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 STARMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6454
Mailing Address - Country:US
Mailing Address - Phone:229-249-8975
Mailing Address - Fax:
Practice Address - Street 1:3564 NORTHCROSSING CIR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6412
Practice Address - Country:US
Practice Address - Phone:229-247-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily