| Doctor Name: | SUSAN TRACY FRYAR KELONE |
| NPI Number: | 1497743645 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | APO4542 |
| Business Practice Address: | 187 Ninth St Jena, LA - 713423901 |
| Business Phone Number: | 3189929200 |
| Business Fax Number: | 3189929245 |
| Mailing Address: | 248 Grays Creek Road, DRY PRONG |
| State: | LA |
| Postal Code: | 71432 |
| Phone Number: | 3186259801 |
| Fax Number: | 3189926234 |
| NPI Enumeration Date: | 10/12/2005 |
| NPI Last Update Date: | 05/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APO4542 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |