Marjory Frederic, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

871409 Issued in NV

Practice address

5940 S Rainbow Blvd Ste 400
Las Vegas, NV 89118-2507

Phone

(702) 854-6853

Fax

(702) 758-7315

NPI assigned

Mar 13, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NV, CA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Living Water Psychiatry PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Las Vegas, NV
  • NPI 1124860929
  NPD Authorized official
• We DO Care LLC

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1013631878
  NPD

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748044800000",
    "number": "1871294447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5940 S RAINBOW BLVD STE 400",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891182507",
            "telephone_number": "702-854-6853",
            "fax_number": "702-758-7315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5940 S RAINBOW BLVD STE 400",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891182507",
            "telephone_number": "702-854-6853",
            "fax_number": "702-758-7315"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3415 S Sepulveda Blvd Fl 11",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900346060",
            "country_code": "US",
            "telephone_number": "702-854-6853",
            "fax_number": "702-758-7315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREDERIC",
        "first_name": "MARJORY",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-13",
        "last_updated": "2025-05-24",
        "certification_date": "2025-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "NV",
            "license": "RN78446",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95032219",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NV",
            "license": "871409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vershawn Dominique Frazier
• Yalonda Frazier
• Angela Lee Frechette, MS, CCC-SLP
• Brenda Liz Fred
• Meaghan Fredell
• Charnette Patrice Frederick
• Renae Frederick
• Tamika Frederick
• Timesha Frederick
• Winita Frederick

• Psychiatric/Mental Health Nurse Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Psychiatric/Mental Health Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2025; 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.