Active NPI
Melanie Ann Fry, PNP
- Pediatric Nurse Practitioner
- Jber, AK
National Provider Identifier
1104183276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 5256149-4405
- Practice address
- 673 MDG
5955 Zeamer Ave
Jber, AK 99506 - Phone
- (907) 580-2908
- Fax
- (575) 356-5948
- NPI assigned
- Apr 13, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 5256149-4405 | UT | Primary |
Addresses
Primary practice location
673 MDG
5955 Zeamer Ave
Jber, AK 99506
Mailing address
673 MDG
5955 Zeamer Ave
Jber, AK 99506
Phone (907) 580-2908
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5256149-4405 | UT | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kelson Physician Partners of Layton, Inc. | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Roy, UT
- NPI 1609086495
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704672000000",
"number": "1104183276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "673 MDG",
"address_2": "5955 ZEAMER AVE",
"city": "JBER",
"state": "AK",
"postal_code": "99506",
"telephone_number": "907-580-2908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "673 MDG",
"address_2": "5955 ZEAMER AVE",
"city": "JBER",
"state": "AK",
"postal_code": "99506",
"telephone_number": "907-580-2908",
"fax_number": "575-356-5948"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRY",
"first_name": "MELANIE",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "PNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-13",
"last_updated": "2024-01-08",
"certification_date": "2023-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "UT",
"license": "5256149-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jber, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.