Provider Demographics
NPI:1275721193
Name:TRIMBLE, ROXANNE KAY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:KAY
Last Name:TRIMBLE
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 1:231 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-1898
Mailing Address - Country:US
Mailing Address - Phone:307-754-6442
Mailing Address - Fax:307-754-6157
Practice Address - Street 1:1220 SUNSHINE AVE STE 101
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4247
Practice Address - Country:US
Practice Address - Phone:307-587-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant