Individual
AMANDA JEAN FRASER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
14 REGIONAL DR, PINEHURST, NC 28374-8850
(910) 295-6661
(910) 295-6524
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-02636
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518135748
—
NC
01
—
NCU839A
MEDICARE PTAN
NC
01
—
NCU839B
MEDICARE PTAN
NC
Enumeration date
02/11/2008
Last updated
10/30/2023
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