Provider Demographics
NPI:1063072536
Name:TRENT, ALVIS BEN
Entity type:Individual
Prefix:
First Name:ALVIS
Middle Name:BEN
Last Name:TRENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N 18TH ST
Mailing Address - Street 2:STE 205
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2931
Mailing Address - Country:US
Mailing Address - Phone:254-433-9455
Mailing Address - Fax:
Practice Address - Street 1:2200 HICKORY ST # 16236
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2345
Practice Address - Country:US
Practice Address - Phone:325-670-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13307363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant