Healthcare Provider Details

I. General information

NPI: 1730084625
Provider Name (Legal Business Name): LARRY TRUMANE ANDRE TRIPLETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2437 21ST ST
FORT CAMPBELL KY
42223-5582
US

IV. Provider business mailing address

1367 FRANCESCA DR
CLARKSVILLE TN
37042-9531
US

V. Phone/Fax

Practice location:
  • Phone: 270-412-8384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: