Provider Demographics
NPI:1922311646
Name:RENFROW, TRENT A (PA-C)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:A
Last Name:RENFROW
Suffix:
Gender:M
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 1:2923 FIREWALK TRCE
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3194
Mailing Address - Country:US
Mailing Address - Phone:281-574-9848
Mailing Address - Fax:
Practice Address - Street 1:700 WESTGREEN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2799
Practice Address - Country:US
Practice Address - Phone:281-578-4600
Practice Address - Fax:281-579-1925
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1091571363A00000X
363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB115483Medicare PIN