Individual
MADISON E FRYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, LDN
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223
(270) 798-8400
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1040212710001
—
PA
01
—
15428040
CAQH
—
Enumeration date
10/25/2021
Last updated
09/23/2024
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