Provider Demographics
NPI:1629314380
Name:FROST, KAYLA S
Entity Type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:S
Last Name:FROST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12629 NE 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-9156
Mailing Address - Country:US
Mailing Address - Phone:405-464-0083
Mailing Address - Fax:
Practice Address - Street 1:12629 NE 38TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-9156
Practice Address - Country:US
Practice Address - Phone:405-464-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program