Healthcare Provider Details

I. General information

NPI: 1285921759
Provider Name (Legal Business Name): TRAVIS M. PALMER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ARKANSAS ST STE 210
LAWRENCE KS
66044-1394
US

IV. Provider business mailing address

330 ARKANSAS ST STE 210
LAWRENCE KS
66044-1394
US

V. Phone/Fax

Practice location:
  • Phone: 785-842-7026
  • Fax: 785-842-7088
Mailing address:
  • Phone: 785-842-7026
  • Fax: 785-842-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number557041
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: