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General NPI Number Information
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NPI Number | 1780556860
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Entity Type | Organization
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Legal Business Name | FRONTIER HEALTH
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1324 MIDLAND DR
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City | KINGSPORT
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State | TN
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Zip | 37664-3044
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Country | US
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Telephone | 423-830-2564
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Fax | 423-467-3644
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Provider Business Mailing Address
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Address Line | 1167 SPRATLIN PARK DR
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City | GRAY
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State | TN
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Zip | 37615-6205
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Country | US
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Telephone | 423-467-3600
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Fax | 423-467-3644
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Authorized Official
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Title or Position | DIRECTOR CONTRACTING/REG COMPLIANCE
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Name | CRISTI LYNN BLALOCK
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Credential | MBA
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Telephone | 423-467-3741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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