Provider Demographics
NPI:1093771446
Name:FROST, KRISTINE HOLLY (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:HOLLY
Last Name:FROST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-375-8858
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:8211 WEST 3500 SOUTH
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044
Practice Address - Country:US
Practice Address - Phone:801-250-9638
Practice Address - Fax:801-250-3204
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110634-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P72067Medicare UPIN
UT5731001Medicare ID - Type Unspecified