Provider Demographics
NPI:1154779866
Name:LINK, TRENT (FNP)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:LINK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MO
Mailing Address - Zip Code:64633-1948
Mailing Address - Country:US
Mailing Address - Phone:660-542-1695
Mailing Address - Fax:660-542-0363
Practice Address - Street 1:807 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:MO
Practice Address - Zip Code:65236-1408
Practice Address - Country:US
Practice Address - Phone:660-548-2012
Practice Address - Fax:660-548-2014
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016003718363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420032761Medicaid