Provider Demographics
NPI:1922368992
Name:MCCLATCHEY, TRILLIS (NNP)
Entity Type:Individual
Prefix:
First Name:TRILLIS
Middle Name:
Last Name:MCCLATCHEY
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 KOSSUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3240
Mailing Address - Country:US
Mailing Address - Phone:765-446-9600
Mailing Address - Fax:765-446-1100
Practice Address - Street 1:1701 CREASY LANE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-1701
Practice Address - Country:US
Practice Address - Phone:765-446-9600
Practice Address - Fax:765-446-1100
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003652A363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal