Provider Demographics
NPI:1003811399
Name:TREVOLT, NORMAN KEITH (ARNP)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:KEITH
Last Name:TREVOLT
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 N. ST FRANCIS
Mailing Address - Street 2:STE 3901
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3858
Mailing Address - Country:US
Mailing Address - Phone:316-268-8500
Mailing Address - Fax:316-291-7993
Practice Address - Street 1:848 N. ST FRANCIS
Practice Address - Street 2:STE 3901
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3858
Practice Address - Country:US
Practice Address - Phone:316-268-8500
Practice Address - Fax:316-291-7993
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44097363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100415820EMedicaid
KS100415820AMedicaid
KS100415820EMedicaid
KS161364Medicare ID - Type Unspecified
KSKA1517004Medicare PIN