Healthcare Provider Details

I. General information

NPI: 1164968236
Provider Name (Legal Business Name): TRINA SMALLEY RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 TOWN SQUARE ATTN: MCXI-CCMH
COPPERAS COVE TX
76522-2826
US

IV. Provider business mailing address

458 TOWN SQ
COPPERAS COVE TX
76522-2826
US

V. Phone/Fax

Practice location:
  • Phone: 254-553-5833
  • Fax:
Mailing address:
  • Phone: 254-553-5833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number867008
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: