Lisa Kay Fredrick, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP60945 Issued in ID

Practice address

700 W Ironwood Dr Ste 350
Coeur D Alene, ID 83814-4487

Phone

(208) 625-5230

Fax

(208) 625-5231

NPI assigned

Mar 5, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559692800000",
    "number": "1316405657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-5085",
            "fax_number": "208-625-5731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR STE 350",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144487",
            "telephone_number": "208-625-5230",
            "fax_number": "208-625-5231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICK",
        "first_name": "LISA",
        "middle_name": "KAY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-05",
        "last_updated": "2019-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "NP60945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Floyd Harold Frazier, LCPC
• Keith Frazier
• Lisa Marie Frazier, LPC, LMFT
• Randi L Frazier, MSW
• Fred Meyer Stores Inc
• Tatem Fredrickson, DO
• Free Air Life, Inc.
• Freedom Counseling, PLLC
• David James Fremouw, PA-C
• Bryce Link French, M.D.

• Nurse Practitioner in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.