Healthcare Provider Details

I. General information

NPI: 1982274254
Provider Name (Legal Business Name): CALLIE ANN ELIZABETH TRENT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALLIE ANN ELIZABETH COBB PA-C

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 CUMBERLAND FALLS HWY
CORBIN KY
40701-2722
US

IV. Provider business mailing address

1419 CUMBERLAND FALLS HWY
CORBIN KY
40701-2722
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-3021
  • Fax: 606-528-7169
Mailing address:
  • Phone: 606-523-3021
  • Fax: 606-528-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5231
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3351
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: