Provider Demographics
NPI:1871980755
Name:FRAZIER, KATIE ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ROXANA
Mailing Address - State:IL
Mailing Address - Zip Code:62084-1337
Mailing Address - Country:US
Mailing Address - Phone:618-255-2895
Mailing Address - Fax:618-255-3097
Practice Address - Street 1:900 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ROXANA
Practice Address - State:IL
Practice Address - Zip Code:62084-1337
Practice Address - Country:US
Practice Address - Phone:618-255-2895
Practice Address - Fax:618-255-3097
Is Sole Proprietor?:No
Enumeration Date:2015-04-18
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012734363LF0000X
IL209.12734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily