Healthcare Provider Details

I. General information

NPI: 1710198585
Provider Name (Legal Business Name): JENNIFER FROST DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE DIVISION OF HEMATOLOGY
JACKSON MS
39216-5116
US

IV. Provider business mailing address

1515 DEVINE ST
JACKSON MS
39202-1312
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-4471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number18569
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: