Provider Demographics
NPI:1275026403
Name:TRIGGS, DEMETRA (MHP)
Entity Type:Individual
Prefix:MISS
First Name:DEMETRA
Middle Name:
Last Name:TRIGGS
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CRIMSON LN
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-8194
Mailing Address - Country:US
Mailing Address - Phone:601-215-9936
Mailing Address - Fax:
Practice Address - Street 1:19295 N 3RD ST STE 2
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8897
Practice Address - Country:US
Practice Address - Phone:985-400-5901
Practice Address - Fax:985-635-8661
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator