Healthcare Provider Details

I. General information

NPI: 1487580403
Provider Name (Legal Business Name): KIPTON TRAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PKWY
HIGH POINT NC
27268-0002
US

IV. Provider business mailing address

542 COUNTY ROAD 114
CARTHAGE TX
75633-5349
US

V. Phone/Fax

Practice location:
  • Phone: 903-754-9795
  • Fax:
Mailing address:
  • Phone: 903-693-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: