Individual
SUSAN TRACY FRYAR KELONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
3425 NORTH BLVD, ALEXANDRIA, LA 71301-3676
(318) 442-2339
(318) 442-2340
Mailing address
248 GRAYS CREEK RD, DRY PRONG, LA 71423-3539
(318) 442-2339
(318) 442-2340
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APO4542
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1620467
—
LA
01
—
P00203569
RAILROAD MEDICARE
LA
Enumeration date
10/12/2005
Last updated
02/09/2022
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