Healthcare Provider Details

I. General information

NPI: 1639864903
Provider Name (Legal Business Name): BETHANY TRAVIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982465 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2465
US

IV. Provider business mailing address

982465 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2465
US

V. Phone/Fax

Practice location:
  • Phone: 531-559-7856
  • Fax: 402-552-2598
Mailing address:
  • Phone: 531-559-7856
  • Fax: 402-552-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number10500
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: