Provider Demographics
NPI:1639247349
Name:TRIVETTE, DONNA EPLEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:EPLEY
Last Name:TRIVETTE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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 888
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-0888
Mailing Address - Country:US
Mailing Address - Phone:252-261-9727
Mailing Address - Fax:
Practice Address - Street 1:113 LIGHT KEEPERS WAY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949
Practice Address - Country:US
Practice Address - Phone:252-261-9727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411829Medicaid
NC1307ROtherBLUE CROSS AND BLUE SHIEL