Healthcare Provider Details

I. General information

NPI: 1154189538
Provider Name (Legal Business Name): TRAVIS BLAKE ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 MULBERRY ST SW
LENOIR NC
28645-5722
US

IV. Provider business mailing address

407 MULBERRY ST SW
LENOIR NC
28645-5722
US

V. Phone/Fax

Practice location:
  • Phone: 828-394-6722
  • Fax:
Mailing address:
  • Phone: 704-813-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number287014
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5020249
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: