=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962028878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARI MARIE FROST FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2020
-----------------------------------------------------
Last Update Date | 06/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 174 KENNEDY MEMORIAL DR
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04901-5134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-861-6140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 386 MADAWASKA AVE
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04967-3947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-649-1208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CNP201214
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------