Healthcare Provider Details

I. General information

NPI: 1033056247
Provider Name (Legal Business Name): KATHERINE FROST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATY FROST

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 LAKE STREET
POINT ARENA CA
95468
US

IV. Provider business mailing address

PO BOX 397
POINT ARENA CA
95468-0397
US

V. Phone/Fax

Practice location:
  • Phone: 707-882-2803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number2C8609F8F2
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: