Provider Demographics
NPI:1427655414
Name:BEFORT, TRENT DYLAN (APRN)
Entity type:Individual
Prefix:MR
First Name:TRENT
Middle Name:DYLAN
Last Name:BEFORT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COMMODORE ST
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-2903
Mailing Address - Country:US
Mailing Address - Phone:620-672-7451
Mailing Address - Fax:620-672-2113
Practice Address - Street 1:203 WATSON ST STE 300
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-3092
Practice Address - Country:US
Practice Address - Phone:620-672-1002
Practice Address - Fax:620-450-1741
Is Sole Proprietor?:No
Enumeration Date:2020-10-03
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily