Provider Demographics
NPI:1881946978
Name:TRIS, JOSEPH PETER (PMHNP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PETER
Last Name:TRIS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 N VICKEY ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-6121
Mailing Address - Country:US
Mailing Address - Phone:928-527-1899
Mailing Address - Fax:928-714-6480
Practice Address - Street 1:2187 N VICKEY ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-6121
Practice Address - Country:US
Practice Address - Phone:928-527-1899
Practice Address - Fax:928-714-6480
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN171784163W00000X
AZAP11719363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse