MEDICARE: SARAH TRAVIS RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian		AR

General Provider Information

NPI Number	:	1871533281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH TRAVIS RD

Provider Business Mailing Address
First Line	:	PO BOX 1824
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72902-1824
Country	:	US
Telephone Number	:	479-441-4000
Fax Number	:	479-441-4829

Provider Business Practice Location Address
First Line	:	1311 S I ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4915
Country	:	US
Telephone Number	:	479-441-4000
Fax Number	:	479-441-4829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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Directions to “ SARAH TRAVIS RD” Practice Location

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