Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 5008281 | NC |
NPI | 1023444338 |
---|---|
Provider Name | Mrs. Jessica Kious-Fry |
First Address | Raleigh, NC 27614-7375 |
Second Address | Raleigh, NC 27614-7375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2013 |
Last Update Date | 10/05/2018 |