Ronald J Frederick, RN
Individual provider Active NPI Registered Nurse · Kayenta, AZ
NPI 1356582142 · NPPES record last updated Mar 9, 2009
Key facts
- NPI
- 1356582142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- RN075432 (AZ)
- Practice address
- Hwy 160/163 BLDG Ka2010
Kayenta, AZ 86033-0368 - Phone
- (928) 697-4279
- Fax
- (928) 697-4145
- NPI assigned
- Mar 9, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN075432 | AZ | MD | Emergency Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN075432 | AZ | Yes |
| Emergency Registered Nurse | 163WE0003X | RN075432 | AZ |
Addresses
Primary practice location
Hwy 160/163 BLDG Ka2010
Kayenta, AZ 86033-0368
Mailing address
PO Box 368
Kayenta, AZ 86033-0368
Phone (928) 697-4279
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060012 | Medicaid | AZ |
Other providers in Kayenta, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.