=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639992837
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTAL TRENT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2024
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3189B HILES RD
-----------------------------------------------------
City | LUCASVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45648-8411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-821-9627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3189 HILES RD
-----------------------------------------------------
City | LUCASVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45648-8411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-821-9627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------