Provider Demographics
NPI:1225411382
Name:FROST, KYLA (ARNP)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 ROCK ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-3102
Mailing Address - Country:US
Mailing Address - Phone:319-283-2651
Mailing Address - Fax:
Practice Address - Street 1:2405 ROCK ISLAND RD
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-3102
Practice Address - Country:US
Practice Address - Phone:319-283-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA116571363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1225411382Medicaid
IAI14492045Medicare PIN