MEDICARE: JYM EDWARD TRIMBLE RN

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	163WH0200X	Home Health Registered Nurse	584835	TX

General Provider Information

NPI Number	:	1447788815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JYM EDWARD TRIMBLE RN

Provider Business Mailing Address
First Line	:	6109 STONE CANYON TRL
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-7392
Country	:	US
Telephone Number	:	325-656-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	6109 STONE CANYON TRL
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-7392
Country	:	US
Telephone Number	:	325-656-7005
Fax Number	:

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

Provider Enumeration Date	:	05/30/2017
Last Update Date	:	07/21/2022

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