MEDICARE: JENNIFER ANN FROST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1942178546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER ANN FROST

Provider Business Mailing Address
First Line	:	1959 NE DIAMOND LAKE BLVD STE 109
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-3501
Country	:	US
Telephone Number	:	541-492-1780
Fax Number	:	833-764-4838

Provider Business Practice Location Address
First Line	:	1959 NE DIAMOND LAKE BLVD STE 109
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-3573
Country	:	US
Telephone Number	:	541-492-1780
Fax Number	:	833-764-4838

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	JENNIFER ANN FROST
Credential	:	DNP-FNP-BC
Telephone Number	:	541-670-1123

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	05/13/2026

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