Provider Demographics
NPI:1952738411
Name:TRIMBLE, KORI LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KORI
Middle Name:LYNN
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KORI
Other - Middle Name:LYNN
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:224 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-3808
Mailing Address - Country:US
Mailing Address - Phone:806-935-7171
Mailing Address - Fax:806-934-7836
Practice Address - Street 1:110 S BLISS AVE
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3804
Practice Address - Country:US
Practice Address - Phone:806-935-1900
Practice Address - Fax:806-934-3343
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330157403Medicaid
389498YMVRMedicare Oscar/Certification