JUSTINE R FROUDE (NPI# 1568960342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568960342 |
| Entity Type | Individual |
| Full Name | JUSTINE R FROUDE |
| Credential | IDMT |
| Practice Address |
57950 Leavenworth St Mcconnell Afb KS 67221-3506 |
| Mailing Address |
2425 N Newberry St Apt 3102 Derby KS 67037-4404 |
| Practice Telephone | 3167594648 |
| Mailing Telephone | 8168771313 |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2018-01-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
57950 LEAVENWORTH ST |
| City | MCCONNELL AFB |
| State | KS |
| Zip Code | 67221-3506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194712828 | Everett J Deleon | Family Medicine | 57950 Leavenworth St, Attn Credentials Manager, Mcconnell Afb, KS 67221-3506 | 2005-09-27 |
| 1073151023 | Arlington Dale Lindskog | Physical Therapist | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2019-12-19 |
| 1083264550 | Brianna Hope Slayback | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2019-09-17 |
| 1538729132 | Matthew Alan Duggan | Physician Assistant | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2019-06-17 |
| 1295212413 | Walter Steven Agudelo | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2018-07-20 |
| 1215425657 | Jordon L Jeans | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2018-05-01 |
| 1144721150 | Daniel Belgam | Student in an Organized Health Care Education/Training Program | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2018-02-24 |
| 1578919049 | Kathryn Rachel Kocher | Pediatrics | 57950 Leavenworth St, Mcconnell Afb, KS 67221 | 2016-05-13 |
| 1265817878 | Rachel M Gurley | Social Worker | 57950 Leavenworth St, 22 Mdos/ Sgow, Mcconnell Afb, KS 67221-3506 | 2015-07-24 |
| 1992190318 | David Clauson | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2015-04-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922528421 | Rose Lee Samples | Nurse Practitioner | 51950 Leavenworth St., Family Health Clinic 22 Mdg, Mcconnell Afb, KS 67221 | 2017-06-26 |
| 1114247913 | Dawn Marie Clifton | Nurse Practitioner | 57950 Leavenworth Ave Bldg 250, 22d Medical Group, Mcconnell Afb, KS 67221 | 2010-06-03 |
| 1467514489 | 22nd Medical Group | Pharmacy | 57590 Leavenworth Bldg 250, Mcconnell Afb, KS 67221 | 2006-12-15 |
| 1336182153 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | Derby Street, Building 352, Mcconnell Afb, KS 67221 | 2006-06-13 |
| 1962707067 | Melissa M Wendt | Physician Assistant | 57950 Leavenworth St Ste 4e1, Mcconnell Afb, KS 67221 | 2011-01-20 |
| 1922232271 | Richard Jimenez Rubi | Military Health Care Provider | 22 Mdg, Mcconnell Afb, KS 67221 | 2009-05-14 |
| 1871581306 | Joshua A Hartman | Emergency Medicine | 57950 Leavenworth St Bldg 248, Mcconnell Afb, KS 67221-3505 | 2005-10-10 |
| 1164052700 | Taylor Holloway | Family Medicine | 57950 Leavenworth St Bldg 250, Mcconnell Afb, KS 67221-3505 | 2020-01-23 |
| 1407296940 | Daniel Richard Galle | Optometrist | 57950 Leavenworth St Ste 4e1, Mcconnell Afb, KS 67221-3505 | 2013-06-28 |
| 1669969424 | Alesha Avis Heinz | Student in an Organized Health Care Education/Training Program | 57950 Leavenworth Street, Suite 4e1, Mcconnell Afb, KS 67221-3506 | 2018-04-17 |
| Find all providers in zip 67221 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255569612 | Janice Renee Faught | Military Health Care Provider | 57950 Leavenworth St Bldg 250, Mcconnell Afb, KS 67221-3506 | 2009-06-24 |
| 1083264550 | Brianna Hope Slayback | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2019-09-17 |
| 1295212413 | Walter Steven Agudelo | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2018-07-20 |
| 1215425657 | Jordon L Jeans | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2018-05-01 |
| 1992190318 | David Clauson | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2015-04-02 |
| 1669873394 | Douglas Livingston IIi | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2014-09-12 |
| 1740613397 | Brooke Elizabeth Prine | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2013-08-19 |
| 1760616015 | John La Cruz | Military Health Care Provider | 22 Mdg, Mcconnell Afb, KS 67221-3712 | 2009-05-14 |
| 1922232271 | Richard Jimenez Rubi | Military Health Care Provider | 22 Mdg, Mcconnell Afb, KS 67221 | 2009-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184968505 | Bobbi Jean Harrington | Military Health Care Provider | 2504 W Manhattan Dr, Wichita, KS 67204-5426 | 2012-11-26 |
| 1972800514 | Derick Lee Tibbetts | Military Health Care Provider | 638 S Whittier St, Wichita, KS 67207-2222 | 2011-02-17 |
| 1396048906 | Colby P Shinkle | Military Health Care Provider | 2176 S Pinecrest St, Wichita, KS 67218-5234 | 2010-12-21 |
| City | MCCONNELL AFB |
| Zip Code | 67221 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.