Provider Demographics
NPI:1972596096
Name:GALE, TRENT EUGENE (FNP)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:EUGENE
Last Name:GALE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402N KAUFMAN ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TX
Mailing Address - Zip Code:75563-5234
Mailing Address - Country:US
Mailing Address - Phone:903-756-5581
Mailing Address - Fax:903-756-5005
Practice Address - Street 1:4002 TECHNOLOGY CTR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2697
Practice Address - Country:US
Practice Address - Phone:903-247-0484
Practice Address - Fax:903-247-0485
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S87578Medicare UPIN