Trevor Van Vliet

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5628 Issued in TN

Practice address

262 Danny Thomas PL
Memphis, TN 38105-3678

Phone

(901) 321-3000

NPI assigned

Jun 29, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Jude Children's Research Hospital, Inc.

  • Pediatrics Physician
  • Memphis, TN
  • NPI 1306335088

  Physician Assistant

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758758400000",
    "number": "1275265001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7121 RICO CV",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381385740",
            "telephone_number": "908-798-1684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 DANNY THOMAS PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381053678",
            "telephone_number": "901-321-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN VLIET",
        "first_name": "TREVOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-29",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "5628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila C Vamplin, L.M.F.T.
• David Alan Van Alstine, MD
• Leigh Karen Van Duren, MD
• Taylor Van Fleet
• Katrina Van Pelt, D.O.
• Jason M Vanatta, MD
• Aubrey Vanblaricom, BCBA
• Mari Kathryn Vanbuskirk, PHARMD
• Tara Nicole Vancleave, DO
• Katheryn N Vancleef

• Physician Assistant in Memphis, TN
• Providers in Memphis, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.