Healthcare Provider Details

I. General information

NPI: 1710810510
Provider Name (Legal Business Name): TRAVIS KACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PRATHER PATH STE 1200
GEORGETOWN KY
40324-9209
US

IV. Provider business mailing address

90 KINGSTON XING APT 2107
BOSSIER CITY LA
71111-6293
US

V. Phone/Fax

Practice location:
  • Phone: 502-603-5220
  • Fax:
Mailing address:
  • Phone: 253-569-8675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number225316
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: