Provider Demographics
NPI:1821409905
Name:FROST, KADIE BIMLE (MD)
Entity Type:Individual
Prefix:
First Name:KADIE
Middle Name:BIMLE
Last Name:FROST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CONTEMPO AVE.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291
Mailing Address - Country:US
Mailing Address - Phone:318-324-0111
Mailing Address - Fax:318-324-9679
Practice Address - Street 1:107 CONTEMPO AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-324-0111
Practice Address - Fax:318-324-9679
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA305389208000000X
MST2798390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics