Healthcare Provider Details

I. General information

NPI: 1427655414
Provider Name (Legal Business Name): TRENT DYLAN BEFORT APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2020
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 WATSON ST STE 300
PRATT KS
67124-3092
US

IV. Provider business mailing address

200 COMMODORE ST
PRATT KS
67124-2903
US

V. Phone/Fax

Practice location:
  • Phone: 620-672-1002
  • Fax: 620-450-1741
Mailing address:
  • Phone: 620-672-7451
  • Fax: 620-672-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79740
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: