1134115835 NPI number — CHRISTA M FROST

Table of content: CHRISTA M FROST (NPI 1134115835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134115835 NPI number — CHRISTA M FROST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FROST
Provider First Name:
CHRISTA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COX
Provider Other First Name:
CHRISTA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134115835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 29TH AVE N STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-327-4304
Provider Business Mailing Address Fax Number:
615-327-7940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 ASHLEY CIR
Provider Second Line Business Practice Location Address:
SUITE 209A
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42104-3337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-782-9994
Provider Business Practice Location Address Fax Number:
270-842-5048
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  3002433 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 74472200 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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