Healthcare Provider Details

I. General information

NPI: 1851283691
Provider Name (Legal Business Name): AXIAL FROST CLINIC IL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WASHINGTON ST STE 1615
CHICAGO IL
60602-1882
US

IV. Provider business mailing address

209 10TH AVE S STE 350
NASHVILLE TN
37203-4166
US

V. Phone/Fax

Practice location:
  • Phone: 615-345-3555
  • Fax:
Mailing address:
  • Phone: 615-345-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALICE HEYWOOD
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 615-231-8560