Provider Demographics
NPI:1396433926
Name:KANN, TRENT WILLIAM (PA)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:WILLIAM
Last Name:KANN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:16511 WILD HORSE CREEK RD APT 313
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1436
Mailing Address - Country:US
Mailing Address - Phone:407-567-8041
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 297A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8200
Practice Address - Country:US
Practice Address - Phone:314-251-6364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2023036248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant