Provider Demographics
NPI:1033131156
Name:PRESTON, TRENA (APRN)
Entity Type:Individual
Prefix:
First Name:TRENA
Middle Name:
Last Name:PRESTON
Suffix:
Gender:F
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:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0719
Mailing Address - Country:US
Mailing Address - Phone:606-439-1316
Mailing Address - Fax:606-435-0752
Practice Address - Street 1:271 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1939
Practice Address - Country:US
Practice Address - Phone:606-439-1316
Practice Address - Fax:606-435-0752
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42682363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78017639Medicaid
KY1371429Medicare PIN
KY78017639Medicaid