Healthcare Provider Details

I. General information

NPI: 1881154722
Provider Name (Legal Business Name): KIMBERLY DAWN TRIGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W MAIN ST
SAINT CLAIRSVILLE OH
43950-8801
US

IV. Provider business mailing address

64457 SAND HILL RD
BELLAIRE OH
43906-9438
US

V. Phone/Fax

Practice location:
  • Phone: 740-968-7006
  • Fax:
Mailing address:
  • Phone: 304-215-8747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.142405.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: