Provider Demographics
NPI:1194060665
Name:FROST, JEREE C
Entity type:Individual
Prefix:MS
First Name:JEREE
Middle Name:C
Last Name:FROST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEREE
Other - Middle Name:C
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 S DOUGLAS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73150-1017
Mailing Address - Country:US
Mailing Address - Phone:405-272-2850
Mailing Address - Fax:405-272-2898
Practice Address - Street 1:3400 S DOUGLAS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73150-1017
Practice Address - Country:US
Practice Address - Phone:405-272-2850
Practice Address - Fax:405-272-2898
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
IL125071378207Q00000X
OK6874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
125.071378OtherLICENSE