Provider Demographics
NPI:1083585723
Name:GLOVER, D'AUNDRE TRENT (PRSS)
Entity type:Individual
Prefix:MR
First Name:D'AUNDRE
Middle Name:TRENT
Last Name:GLOVER
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 WOODS RUN RD
Mailing Address - Street 2:
Mailing Address - City:RIVESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26588-8019
Mailing Address - Country:US
Mailing Address - Phone:304-296-1731
Mailing Address - Fax:
Practice Address - Street 1:100 CROSSWIND DR
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:WV
Practice Address - Zip Code:26554-9162
Practice Address - Country:US
Practice Address - Phone:304-296-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker