Provider Demographics
NPI:1407691645
Name:GILLEY, TRINA ARLEEN (CPHT, CHW)
Entity type:Individual
Prefix:MISS
First Name:TRINA
Middle Name:ARLEEN
Last Name:GILLEY
Suffix:
Gender:F
Credentials:CPHT, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 GENE STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:RAGLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70657-6322
Mailing Address - Country:US
Mailing Address - Phone:337-348-2125
Mailing Address - Fax:337-494-0303
Practice Address - Street 1:820 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:LA
Practice Address - Zip Code:70669-5393
Practice Address - Country:US
Practice Address - Phone:337-433-4692
Practice Address - Fax:337-494-0303
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACPT.002804183700000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No183700000XPharmacy Service ProvidersPharmacy Technician