Healthcare Provider Details

I. General information

NPI: 1477413995
Provider Name (Legal Business Name): TRAVIS RAMIREZ RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2532 JACKSBORO HWY
FORT WORTH TX
76114-2206
US

IV. Provider business mailing address

2532 JACKSBORO HWY
FORT WORTH TX
76114-2206
US

V. Phone/Fax

Practice location:
  • Phone: 682-399-6342
  • Fax:
Mailing address:
  • Phone: 682-399-6342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDT83891
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: