Healthcare Provider Details

I. General information

NPI: 1154298677
Provider Name (Legal Business Name): ELEMENTAL PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 JUNE ST
HOOD RIVER OR
97031-1512
US

IV. Provider business mailing address

1767 12TH ST # 171
HOOD RIVER OR
97031-9531
US

V. Phone/Fax

Practice location:
  • Phone: 541-224-7951
  • Fax: 541-224-7952
Mailing address:
  • Phone: 541-224-7951
  • Fax: 541-224-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LYNNE ANNE FROST BARON
Title or Position: EXECUTIVE CLINICAL DIRECTOR
Credential: DNP, APRN
Phone: 541-224-7951