Provider Demographics
NPI:1083429088
Name:MUTTER, TRENT ALEX (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:ALEX
Last Name:MUTTER
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 BURNING TREE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-1900
Mailing Address - Country:US
Mailing Address - Phone:615-499-1062
Mailing Address - Fax:
Practice Address - Street 1:1127 BURNING TREE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-1900
Practice Address - Country:US
Practice Address - Phone:615-499-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38201363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health