Basic Information
| Provider Information | |||||||||
| NPI: | 1700877073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRENTHAM | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 W SPRINGDALE AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379175158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656379711 | ||||||||
| FaxNumber: | 8656371278 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 W SPRINGDALE AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379175158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656379711 | ||||||||
| FaxNumber: | 8656371278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 12/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD0000031650 | TN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 4059342 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 3845687 | 05 | TN | MEDICAID |