Healthcare Provider Details

I. General information

NPI: 1164368338
Provider Name (Legal Business Name): TREVIN MICHAEL WILLIAMSON-SCOGGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N MILLER
HAY SPRINGS NE
69347-4216
US

IV. Provider business mailing address

5036 410TH LN
HAY SPRINGS NE
69347-4216
US

V. Phone/Fax

Practice location:
  • Phone: 308-432-4050
  • Fax: 308-432-3992
Mailing address:
  • Phone: 307-823-3960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: