Healthcare Provider Details

I. General information

NPI: 1114845872
Provider Name (Legal Business Name): TRAVIS JAMES MCQUEEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 E 11TH CT
ANCHORAGE AK
99504-2275
US

IV. Provider business mailing address

8601 E 11TH CT
ANCHORAGE AK
99504-2275
US

V. Phone/Fax

Practice location:
  • Phone: 907-885-4327
  • Fax: 907-222-9984
Mailing address:
  • Phone: 907-885-4327
  • Fax: 907-222-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: