Individual
DR. CHARLEN FRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 BRULE ST BLDG 871, FORT KNOX, KY 40121-6100
(502) 626-9745
Mailing address
PO BOX 2309, ELIZABETHTOWN, KY 42702-2309
(270) 706-1131
(270) 706-1167
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38012
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000300289
BC/BS PIN
KY
01
—
2443136000
PASSPORT ADVANTAGE
KY
01
—
50001558
PASSPORT
KY
05
—
64067952
—
KY
01
—
P00081750
RAILROAD MCR
KY
Enumeration date
03/08/2006
Last updated
06/15/2023
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