Provider Demographics
NPI:1871312751
Name:PERSINGER, TRISTON MARIE (CPM LM)
Entity type:Individual
Prefix:
First Name:TRISTON
Middle Name:MARIE
Last Name:PERSINGER
Suffix:
Gender:F
Credentials:CPM LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400-3 E CENTRAL TEXAS EXPY STE D
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-7396
Mailing Address - Country:US
Mailing Address - Phone:254-300-1337
Mailing Address - Fax:512-777-4067
Practice Address - Street 1:4400-3 E CENTRAL TEXAS EXPY STE D
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-7396
Practice Address - Country:US
Practice Address - Phone:254-300-1337
Practice Address - Fax:512-777-4067
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99573176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife