Healthcare Provider Details

I. General information

NPI: 1265174098
Provider Name (Legal Business Name): TRAVIS HOVERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 E CENTRAL TEXAS EXPY STE 403
KILLEEN TX
76543-7378
US

IV. Provider business mailing address

3210 E CENTRAL TEXAS EXPY STE 403
KILLEEN TX
76543-7378
US

V. Phone/Fax

Practice location:
  • Phone: 125-424-5936
  • Fax:
Mailing address:
  • Phone: 125-424-5936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number81011
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: