Healthcare Provider Details

I. General information

NPI: 1083522833
Provider Name (Legal Business Name): TERESA TRENT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N 2ND AVE
DODGE CITY KS
67801-4411
US

IV. Provider business mailing address

804 N 2ND AVE
DODGE CITY KS
67801-4411
US

V. Phone/Fax

Practice location:
  • Phone: 620-227-1562
  • Fax:
Mailing address:
  • Phone: 620-227-1562
  • Fax: 620-227-1563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14055
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: