Healthcare Provider Details

I. General information

NPI: 1215488507
Provider Name (Legal Business Name): TRAVIS R. NOBLE APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 NEW SANGER AVE STE A
WACO TX
76712-4054
US

IV. Provider business mailing address

PO BOX 21327
WACO TX
76702-1327
US

V. Phone/Fax

Practice location:
  • Phone: 254-399-5400
  • Fax: 254-772-8669
Mailing address:
  • Phone: 254-399-5441
  • Fax: 254-776-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP132069
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP132069
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: