Healthcare Provider Details

I. General information

NPI: 1811187933
Provider Name (Legal Business Name): TRISHA ANN KALL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISHA ANN PICKENS

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5870 N. HIATUS RD.
TAMARAC FL
33321
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-5072
  • Fax:
Mailing address:
  • Phone: 937-762-1306
  • Fax: 937-522-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.07994-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.07994
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: