# BOERNE REGEN AND ANTI-AGING CENTER, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417558420
- **Authorized official:** KASEY FRYE DC, APRN, FNP-BC (MANAGING MEMBER)
- **Authorized official phone:** (956) 763-7767

## Contact information

- **Practice address:** 107 REED RD, BOERNE, TX 78006-8605
- **Practice address phone:** (210) 884-2225
- **Mailing address:** 29630 DOUBLE EAGLE CIR, FAIR OAKS RANCH, TX 78015-4934

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/05/2020
- **Last updated:** 11/05/2020