MEDICARE: MRS. RACHEL KATHERINE TRIMM-SCARBROUGH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R870701	MS

General Provider Information

NPI Number	:	1215176706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL KATHERINE TRIMM-SCARBROUGH FNP

Provider Business Mailing Address
First Line	:	785 OHIO AVE
Second Line	:	SUITE 3G
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-6217
Country	:	US
Telephone Number	:	662-624-8000
Fax Number	:	662-627-2900

Provider Business Practice Location Address
First Line	:	580 FRIARS POINT RD
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-9734
Country	:	US
Telephone Number	:	662-624-4316
Fax Number	:	662-621-1151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2009
Last Update Date	:	12/23/2013

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