Provider Demographics
NPI:1962060616
Name:TRIMMELL, MANDY JO (PA-C)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:JO
Last Name:TRIMMELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 RAINBOW CT
Mailing Address - Street 2:
Mailing Address - City:BUHLER
Mailing Address - State:KS
Mailing Address - Zip Code:67522-8076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:651 E PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7408
Practice Address - Country:US
Practice Address - Phone:785-825-7251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02306363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant