Individual provider Active NPI

Carolyn Lisa Fry, ACNP-BC,FNP-C, RNFA

  • Acute Care Nurse Practitioner
  • Greenville, TX
National Provider Identifier
1700403276
Registry record updated Apr 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
1000942 Issued in TX
Practice address
4211 Joe Ramsey Blvd E Ste 100
Greenville, TX 75401-7856
Phone
(903) 408-7768
Fax
(903) 408-7769
NPI assigned
Jul 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse First Assistant 163WR0006X 741285 TX
Family Nurse Practitioner 363LF0000X 1000942 TX
Acute Care Nurse Practitioner 363LA2100X 1000942 TX Primary

Addresses

Primary practice location

4211 Joe Ramsey Blvd E Ste 100
Greenville, TX 75401-7856

Mailing address

4211 Joe Ramsey Blvd E Ste 100
Greenville, TX 75401-7856
Phone (903) 408-7768

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20210811003617 TX Practitioner - Nurse Practitioner 1355745449 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Texas Oncology PAGroup PAC ID 5395658934, 1,001 clinicians

Practice addresses (Care Compare)

4215 Joe Ramsey Blvd
Greenville, TX 75401-7852
Phone (903) 408-5112

Hospital & facility affiliations

  • Hunt Regional Medical Center Hospital, Greenville, TX, CCN 450352
  • Baylor Scott and White Medical Center Lake Pointe Hospital, Rowlett, TX, CCN 450742

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
741285TXMDRegistered Nurse First Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Oncology PA Current Accepting new patients
Texas Oncology PA CurrentSince Apr 10, 2024 Accepting new patients
Texas Oncology PA CurrentSince Apr 10, 2024 Accepting new patients
Texas Em-I Medical Services, PA Past Accepting new patients

Locations

7848 Gateway Blvd E
El Paso, TX 79915
Phone (915) 599-1313

4215 Ramsey Blvd E
Greenville, TX 75401
Phone (903) 408-1470

4211 Joe Ramsey Blvd E
Ste 108
Greenville, TX 75401
Phone (469) 800-3400

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

Interoperability endpoints

  • Direct secure messaging: carolyn.fry@txo.ikm.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1593561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648771200000",
    "number": "1700403276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 JOE RAMSEY BLVD E STE 100",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754017856",
            "telephone_number": "903-408-7768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 JOE RAMSEY BLVD E STE 100",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754017856",
            "telephone_number": "903-408-7768",
            "fax_number": "903-408-7769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRY",
        "first_name": "CAROLYN",
        "middle_name": "LISA",
        "name_prefix": "Mrs.",
        "credential": "ACNP-BC,FNP-C, RNFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-01",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "TX",
            "license": "741285",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1000942",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1000942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, TX

Sources for this page

Verify at the official NPI Registry.