Provider Demographics
NPI:1215176706
Name:TRIMM-SCARBROUGH, RACHEL KATHERINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:KATHERINE
Last Name:TRIMM-SCARBROUGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:785 OHIO AVE
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6217
Mailing Address - Country:US
Mailing Address - Phone:662-624-8000
Mailing Address - Fax:662-627-2900
Practice Address - Street 1:580 FRIARS POINT RD
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-9734
Practice Address - Country:US
Practice Address - Phone:662-624-4316
Practice Address - Fax:662-621-1151
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I505308Medicare PIN