Provider Demographics
NPI:1730217324
Name:TRIVETTE, KEVIN WAYNE (ATC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WAYNE
Last Name:TRIVETTE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CEDAR HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642-4414
Mailing Address - Country:US
Mailing Address - Phone:423-357-4510
Mailing Address - Fax:
Practice Address - Street 1:1800 LEGION DRIVE
Practice Address - Street 2:DOBYNS-BENNETT HIGH SCHOOL
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664
Practice Address - Country:US
Practice Address - Phone:423-378-8537
Practice Address - Fax:423-378-8534
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer