Healthcare Provider Details

I. General information

NPI: 1730077256
Provider Name (Legal Business Name): MR. TRAVIS LEVI PATTERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 KALAMAZOO AVE SE APT 209
GRAND RAPIDS MI
49507-3968
US

IV. Provider business mailing address

2619 KALAMAZOO AVE SE APT 209
GRAND RAPIDS MI
49507-3968
US

V. Phone/Fax

Practice location:
  • Phone: 805-222-0032
  • Fax:
Mailing address:
  • Phone: 805-222-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: