Provider Demographics
NPI:1750833984
Name:TREST, CLINT (PMHNP)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:
Last Name:TREST
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 TOULON ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-6059
Mailing Address - Country:US
Mailing Address - Phone:601-941-4688
Mailing Address - Fax:
Practice Address - Street 1:3550 HIGHWAY 468 W
Practice Address - Street 2:
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193-5529
Practice Address - Country:US
Practice Address - Phone:601-351-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901732363LP0808X
TN22319363LP0808X
WAAP61142303363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health