=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841148137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES RAY FROST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2026
-----------------------------------------------------
Last Update Date | 03/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1027 EVERGREEN ST
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99709-4306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-451-8164
-----------------------------------------------------
Fax | 907-451-0273
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 WENDELL AVE
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99701-4837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-451-6960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------