Provider Demographics
NPI:1831086875
Name:MCKINNEY TRUSTY, THERESA E
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:E
Last Name:MCKINNEY TRUSTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 OPAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1650
Mailing Address - Country:US
Mailing Address - Phone:832-788-6240
Mailing Address - Fax:
Practice Address - Street 1:12105 OPAL CREEK DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1650
Practice Address - Country:US
Practice Address - Phone:832-788-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider