Healthcare Provider Details

I. General information

NPI: 1003584608
Provider Name (Legal Business Name): TRAVIS ANDREW KYLE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W EAGLE DR
DECATUR TX
76234-3745
US

IV. Provider business mailing address

1512 TEASLEY LN
DENTON TX
76205-7282
US

V. Phone/Fax

Practice location:
  • Phone: 940-442-5209
  • Fax: 940-222-2720
Mailing address:
  • Phone: 940-442-5209
  • Fax: 940-222-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14482
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: